Provider Demographics
NPI:1316569874
Name:PAM CUBED REHABILITATION HOSPITAL OF FARGO LLC
Entity Type:Organization
Organization Name:PAM CUBED REHABILITATION HOSPITAL OF FARGO LLC
Other - Org Name:PAM REHABILITATION HOSPITAL OF FARGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MISITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-731-9660
Mailing Address - Street 1:1828 GOOD HOPE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4671 38TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7866
Practice Address - Country:US
Practice Address - Phone:701-404-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty