Healthcare Provider Details

I. General information

NPI: 1861054637
Provider Name (Legal Business Name): ENCOMPASS FAMILY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 5TH ST N
FARGO ND
58102-4815
US

IV. Provider business mailing address

320 5TH ST N
FARGO ND
58102-4815
US

V. Phone/Fax

Practice location:
  • Phone: 701-478-1105
  • Fax:
Mailing address:
  • Phone: 701-478-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SAMANTHA STEWART
Title or Position: MEMBER
Credential:
Phone: 701-405-4344