Healthcare Provider Details

I. General information

NPI: 1336043165
Provider Name (Legal Business Name): PLACE OF SOLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 11TH ST N
FARGO ND
58102-2217
US

IV. Provider business mailing address

1629 11TH ST N
FARGO ND
58102-2217
US

V. Phone/Fax

Practice location:
  • Phone: 612-282-5568
  • Fax:
Mailing address:
  • Phone: 612-282-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOHAMED ADAN MOHAMED
Title or Position: OWNER
Credential:
Phone: 612-282-5568