NPIMap

Organization Active NPI

Red River Human Services Foundation

  • Intellectual Disabilities Intermediate Care Facility
  • West Fargo, ND
National Provider Identifier
1861810053
Registry record updated Apr 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
RED RIVER HUMAN SERVICES FOUNDATION
Practice address
903 Mulberry LN
West Fargo, ND 58078-5000
Phone
(701) 532-3451
Fax
(701) 235-1051
NPI assigned
Apr 3, 2014
Last updated
Apr 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2014

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

Authorized official

Name
Thomas Newberger, CPA
Title
Executive Director
Phone
(701) 235-0971

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X ND Primary

Addresses

Primary practice location

903 Mulberry LN
West Fargo, ND 58078-5000

Mailing address

2506 35TH Ave S
Suite a
Fargo, ND 58104-8897
Phone (701) 235-0971

Other identifiers 3

IdentifierTypeStateIssuer
1881717122MedicaidND
1700908589MedicaidND
1972626216MedicaidND

Medicare participation

Medicare enrollment files
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 1861810053. Details of each certification follow.

  • CCN 35G082 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 35G082

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Red River Human Services - 903
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 5, 2014
Last certification
May 8, 2025
Beds
5
Ownership / control type
Private (non-profit)
Facility address
903 Mulberry Lane
West Fargo, ND 58078

National Provider Directory

National Provider Directory
Tax ID family
Red River Human Services Foundation15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396483200000",
    "number": "1861810053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 35TH AVE S",
            "address_2": "SUITE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048897",
            "telephone_number": "701-235-0971",
            "fax_number": "701-235-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 MULBERRY LN",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580785000",
            "telephone_number": "701-532-3451",
            "fax_number": "701-235-1051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED RIVER HUMAN SERVICES FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2014-04-03",
        "status": "A",
        "authorized_official_last_name": "NEWBERGER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "701-235-0971",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881717122",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700908589",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972626216",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Fargo, ND

Sources for this page

Verify at the official NPI Registry.