Provider Demographics
NPI:1275147654
Name:WEST FARGO OPS LLC
Entity Type:Organization
Organization Name:WEST FARGO OPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVACZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-241-8204
Mailing Address - Street 1:5900 CLEARWATER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8961
Mailing Address - Country:US
Mailing Address - Phone:952-746-3630
Mailing Address - Fax:952-241-8232
Practice Address - Street 1:645 33RD AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8074
Practice Address - Country:US
Practice Address - Phone:701-551-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility