Healthcare Provider Details

I. General information

NPI: 1003741695
Provider Name (Legal Business Name): WHITE VAULT INVESTMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 2ND ST S APT 517
FARGO ND
58103-2592
US

IV. Provider business mailing address

101 2ND ST S APT 517
FARGO ND
58103-2592
US

V. Phone/Fax

Practice location:
  • Phone: 701-729-8768
  • Fax:
Mailing address:
  • Phone: 701-729-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BISMARK K ASARE
Title or Position: MANAGER
Credential: MPP,MSC,BSC
Phone: 701-729-8768