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NPI Code Detail

MEDICARE: VILLAGE FAMILY SERVICE CENTER

MEDICARE: VILLAGE FAMILY SERVICE CENTER
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1142ND
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)1142ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13Z71FIOTHERMNUBH
28441481OTHERMNBCBSMN

General Provider Information

NPI Number : 1952679318
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLAGE FAMILY SERVICE CENTER
Provider Business Mailing Address
First Line : 1201 25TH ST S
Second Line : PO BOX 9859
City : FARGO
State : ND
Zip : 58103-2311
Country : US
Telephone Number : 701-451-4900
Fax Number : 701-451-4891
Provider Business Practice Location Address
First Line : 2701 12TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-8753
Country : US
Telephone Number : 701-293-3384
Fax Number : 701-293-3384
Authorized Official
Title or Position : VP OF HUMAN RESOURCES
Name : CANDY HAUGEN
Credential :
Telephone Number : 701-451-4900
Provider Enumeration Date : 12/13/2011
Last Update Date : 10/30/2019

Similar Medicare Providers

1568492353 — VILLAGE FAMILY SERVICE CENTER
Practice Location Address:
2701 12TH AVE S
FARGO, ND
58103-8753
Practice Phone: 701-451-4900
Practice Fax: 651-925-0057
1174677785 — MRS. PEGGY L STENEHJEM-TITUS M.ED, LAC
Practice Location Address:
2701 12TH AVE S
FARGO, ND
58103-8753
Practice Phone: 701-451-4900
Practice Fax: 651-925-0057
1316121189 — JOHN A LYON LCSW
Practice Location Address:
2701 12TH AVE S
FARGO, ND
58103-8753
Practice Phone: 701-451-4900
Practice Fax: 651-925-0057
1336370667 — JERILYN J FISCHER-ARNOLD LMFT
Practice Location Address:
2701 12TH AVE S
FARGO, ND
58103-8753
Practice Phone: 701-451-4900
Practice Fax: 651-925-0057
1003146861 — RACHEL A BLUMHARDT
Practice Location Address:
2701 12TH AVE S
FARGO, ND
58103-8753
Practice Phone: 701-451-4900
Practice Fax: 651-925-0057
1386057123 — ADAM PRIEBNOW
Practice Location Address:
2701 12TH AVE S
FARGO, ND
58103-8753
Practice Phone: 701-451-4900
Practice Fax: 651-925-0057

Directions to “VILLAGE FAMILY SERVICE CENTER ” Practice Location

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