Healthcare Provider Details

I. General information

NPI: 1487537031
Provider Name (Legal Business Name): ACAI AGUAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 AMBER VALLEY PKWY S APT 309
FARGO ND
58104-8704
US

IV. Provider business mailing address

5002 AMBER VALLEY PKWY S APT 309
FARGO ND
58104-8704
US

V. Phone/Fax

Practice location:
  • Phone: 701-612-1837
  • Fax:
Mailing address:
  • Phone: 701-612-1837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number46222
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: