Healthcare Provider Details

I. General information

NPI: 1063286821
Provider Name (Legal Business Name): SEEDS OF EDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 1ST AVE E
MC LAUGHLIN SD
57642-2028
US

IV. Provider business mailing address

425 MAIN ST S
MINOT ND
58701-4414
US

V. Phone/Fax

Practice location:
  • Phone: 808-830-7595
  • Fax: 833-846-8690
Mailing address:
  • Phone: 808-830-7595
  • Fax: 833-846-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ISAIAH KELLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-830-7595