Villa Nazareth

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

30824 Issued in ND

Legal business name

VILLA NAZARETH

Doing business as

Friendship, Inc.

Practice address

2424 18TH St S
Fargo, ND 58103-5110

Phone

(701) 293-6180

Fax

(701) 232-6104

NPI assigned

May 9, 2008

Last updated

May 9, 2008By 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

Mr. Dave Keeler

Title

Cfo

Phone

(701) 235-8217

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Friendship, Inc. Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417124462. Details of each certification follow.

• CCN 35G031 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 35G031

Legal name

Friendship-2424

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Oct 1, 1985

Last certification

Mar 13, 2025

Beds

6

Ownership / control type

Private (non-profit)

Facility address

2424 18th St S
Fargo, ND 58103

Tax ID family

Friendship Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

• Villa Nazareth

  dba Friendship, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Park River, ND
  • NPI 1134395395
  NPD tax ID
• Villa Nazareth

  dba Friendship, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Grafton, ND
  • NPI 1316113590
  NPD tax ID
• Villa Nazareth

  dba Friendship Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Park River, ND
  • NPI 1326215369
  NPD tax ID
• Villa Nazareth

  dba Friendship Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Fargo, ND
  • NPI 1326215377
  NPD tax ID
• Villa Nazareth

  dba Friendship, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Fargo, ND
  • NPI 1598931784
  NPD tax ID

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1417124462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 PAGE DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032315",
            "telephone_number": "701-235-8217",
            "fax_number": "701-235-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 18TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035110",
            "telephone_number": "701-293-6180",
            "fax_number": "701-232-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLA NAZARETH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-09",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "KEELER",
        "authorized_official_first_name": "DAVE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "701-235-8217",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "ND",
            "license": "30824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30824",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Friendship, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Lynn Vilhauer, LCSW
• Diana Vilkama
• Villa Maria (Villa Maria Adult DayCare)
• Villa Nazareth (Friendship Inc)
• Villa Nazareth (Friendship Inc.)
• Villa Nazareth (Friendship, Inc.)
• Villa Nazareth (Friendship Inc.)
• Villa Nazareth (Friendship, Inc.)
• Myrla Villa
• Village Family Service Center

• Intellectual Disabilities Intermediate Care Facility in Fargo, ND
• Providers in Fargo, ND by specialty
• Intellectual Disabilities Intermediate Care Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.