Balm of Gilead Healthcare Clinic LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

BALM OF GILEAD HEALTHCARE CLINIC LLC

Practice address

210 Gateway Dr NE Ste 1
East Grand Forks, MN 56721-1621

Phone

(218) 207-2020

Fax

(800) 582-1083

NPI assigned

Mar 10, 2023

Last updated

Feb 10, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Merit Fongwi Laduna FondongNPI 1306221460

Title

NP

Phone

(218) 779-9437

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Tax ID family

Balm of Gilead Healthcare Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Balm of Gilead Healthcare LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • East Grand Forks, MN
  • NPI 1730889882
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Merit FL Fondong, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • East Grand Forks, MN
  • NPI 1306221460
  Medicare reassignment Care Compare group NPD Authorized official
• Kimberly Nicole Williams, APRN, FNP-C

  • Family Nurse Practitioner
  • East Grand Forks, MN
  • NPI 1639693864
  Medicare reassignment Care Compare group NPD
• Timothy Tita Etonde, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Grand Forks, ND
  • NPI 1811787666

  MN

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1154022895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 GATEWAY DR NE STE 1",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211621",
            "telephone_number": "218-207-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 GATEWAY DR NE STE 1",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211621",
            "telephone_number": "218-207-2020",
            "fax_number": "800-582-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALM OF GILEAD HEALTHCARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-10",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "FONDONG",
        "authorized_official_first_name": "MERIT",
        "authorized_official_middle_name": "FONGWI LADUNA",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "218-779-9437"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Anderson, P.T., D.P.T.
• Area Special Education Cooperative #997
• Denise Arneson-Kvasager
• Barbara Ann Arntson, MS, RD, LD
• Andrea M Auch, PT
• Balm of Gilead Healthcare LLC
• Robert William Beattie, M.D
• Kaitlyn Elizabeth Benz, LSW, LADC
• Jon Edwin Bradbury, MD
• Craig W. Burns, LMSW

• Psychiatric/Mental Health Nurse Practitioner in East Grand Forks, MN
• Providers in East Grand Forks, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.