NPIMap

Organization Active NPI

Prairie St. John's, LLC

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
National Provider Identifier
1366681918
Registry record updated Feb 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
597-1-1-08A Issued in ND
Legal business name
PRAIRIE ST. JOHN'S, LLC
Practice address
510 4TH St. South
Fargo, ND 58103
Phone
(401) 478-7517
Fax
(701) 478-7524
NPI assigned
Feb 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2009

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

Authorized official

Name
Mr. Thomas Eide
Title
Cfo
Phone
(701) 476-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 597-1-1-08A ND Primary

Addresses

Primary practice location

510 4TH St. South
Fargo, ND 58103

Mailing address

510 4TH St. South
Fargo, ND 58103
Phone (401) 478-7517

National Provider Directory

National Provider Directory
Tax ID family
Prairie St John's Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

510 4th St S
Fargo, ND 58103
Phone (701) 476-7200

NPI Registry JSON

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

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233792000000",
    "number": "1366681918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 4TH ST. SOUTH",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "401-478-7517",
            "fax_number": "701-478-7524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 4TH ST. SOUTH",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "401-478-7517",
            "fax_number": "701-478-7524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE ST. JOHN'S, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-05",
        "last_updated": "2009-02-05",
        "status": "A",
        "authorized_official_last_name": "EIDE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "701-476-7200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "ND",
            "license": "597-1-1-08A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.