MEDICARE: SOCIAL BRIDGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1750246179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOCIAL BRIDGE LLC

Provider Business Mailing Address
First Line	:	4357 13TH AVE S STE 200
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-7504
Country	:	US
Telephone Number	:	701-730-9489
Fax Number	:

Provider Business Practice Location Address
First Line	:	4357 13TH AVE S STE 200
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-7504
Country	:	US
Telephone Number	:	701-730-9489
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIAZIZ AHMED HASSAN
Credential	:
Telephone Number	:	701-730-9489

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	01/19/2026

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Directions to “SOCIAL BRIDGE LLC ” Practice Location

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