NPIMap

Organization Active NPI

Balm of Gilead Healthcare LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • East Grand Forks, MN
National Provider Identifier
1730889882
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
BALM OF GILEAD HEALTHCARE LLC
Practice address
1618 Central Ave NE
East Grand Forks, MN 56721-1335
Phone
(218) 779-9437
NPI assigned
Mar 7, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Muluh Fongwi Fongwi Laduna Fondong
Title
Partner
Phone
(218) 779-9437

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

1618 Central Ave NE
East Grand Forks, MN 56721-1335

Mailing address

2448 42ND Ave S
Grand Forks, ND 58201-3483
Phone (218) 779-9437

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1730889882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2448 42ND AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013483",
            "telephone_number": "218-779-9437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1618 CENTRAL AVE NE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211335",
            "telephone_number": "218-779-9437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALM OF GILEAD HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-07",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "FONDONG",
        "authorized_official_first_name": "MULUH FONGWI",
        "authorized_official_middle_name": "FONGWI LADUNA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "218-779-9437"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": []
}

Other providers in East Grand Forks, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.