Healthcare Provider Details

I. General information

NPI: 1750984084
Provider Name (Legal Business Name): ENCOMPASS FAMILY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CENTRAL AVE S STE 2
VALLEY CITY ND
58072-3325
US

IV. Provider business mailing address

320 5TH ST N
FARGO ND
58102-4815
US

V. Phone/Fax

Practice location:
  • Phone: 701-478-1105
  • Fax:
Mailing address:
  • Phone: 701-478-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA STEWART
Title or Position: OWNER
Credential:
Phone: 701-405-4344