1790385441 NPI number — RED RIVER HUMAN SERVICES FOUNDATION

Table of content: (NPI 1790385441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790385441 NPI number — RED RIVER HUMAN SERVICES FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RED RIVER HUMAN SERVICES FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790385441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2506 35TH AVE S STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58104-8897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-532-3402
Provider Business Mailing Address Fax Number:
701-235-1051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 6TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-591-3400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SACKETT
Authorized Official First Name:
RITA
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL DIRECTOR
Authorized Official Telephone Number:
701-532-3402

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1455780 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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