Healthcare Provider Details

I. General information

NPI: 1699689307
Provider Name (Legal Business Name): CITY OF FARGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 1ST AVE N UNIT B
FARGO ND
58102-4120
US

IV. Provider business mailing address

1240 25TH ST S
FARGO ND
58103-2367
US

V. Phone/Fax

Practice location:
  • Phone: 701-476-6723
  • Fax:
Mailing address:
  • Phone: 701-241-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELISSA PERALA
Title or Position: ACCOUNTANT
Credential:
Phone: 701-241-1392