{
"Npi": {
"NPI": "1699689307",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "CITY OF FARGO",
"ParentOrgTIN": null,
"OrgName": "CITY OF FARGO",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1240 25TH ST S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FARGO",
"MailingAddressStateName": "ND",
"MailingAddressPostalCode": "58103-2367",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "701-241-1360",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2001 1ST AVE N UNIT B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FARGO",
"PracticeLocationAddressStateName": "ND",
"PracticeLocationAddressPostalCode": "58102-4120",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "701-476-6723",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/30/2026",
"LastUpdateDate": "09/30/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PERALA",
"AuthorizedOfficialFirstName": "MELISSA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ACCOUNTANT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "701-241-1392",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}