Provider Demographics
NPI:1154083905
Name:EMERALD CARES
Entity Type:Organization
Organization Name:EMERALD CARES
Other - Org Name:EMERALD CARES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TEHTEE
Authorized Official - Middle Name:KOU
Authorized Official - Last Name:PAYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:678-683-5125
Mailing Address - Street 1:4955 17TH AVE S APT 224
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3571
Mailing Address - Country:US
Mailing Address - Phone:678-683-5125
Mailing Address - Fax:
Practice Address - Street 1:15 21ST ST S STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1435
Practice Address - Country:US
Practice Address - Phone:701-347-1516
Practice Address - Fax:701-540-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health