Healthcare Provider Details

I. General information

NPI: 1750246179
Provider Name (Legal Business Name): SOCIAL BRIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 13TH AVE S STE 200
FARGO ND
58103-7504
US

IV. Provider business mailing address

4357 13TH AVE S STE 200
FARGO ND
58103-7504
US

V. Phone/Fax

Practice location:
  • Phone: 701-730-9489
  • Fax:
Mailing address:
  • Phone: 701-730-9489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ABDIAZIZ AHMED HASSAN
Title or Position: OWNER
Credential:
Phone: 701-730-9489