Provider Demographics
NPI:1154493856
Name:FAMILY HEALTH CARE CENTER
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE CENTER
Other - Org Name:FAMILY HEALTHCARE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZ-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-271-1494
Mailing Address - Street 1:301 NP AVE
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-271-3344
Mailing Address - Fax:701-551-7533
Practice Address - Street 1:5225 23RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7927
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND010396Medicaid