Provider Demographics
NPI:1487821922
Name:ADULTS ADOPTING SPECIAL KIDS
Entity Type:Organization
Organization Name:ADULTS ADOPTING SPECIAL KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRISTON
Authorized Official - Middle Name:F
Authorized Official - Last Name:FERNADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-4457
Mailing Address - Street 1:5201 BISHOPS BLVD S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7608
Mailing Address - Country:US
Mailing Address - Phone:701-235-4457
Mailing Address - Fax:701-356-7993
Practice Address - Street 1:5201 BISHOPS BLVD S
Practice Address - Street 2:SUITE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7608
Practice Address - Country:US
Practice Address - Phone:701-235-4457
Practice Address - Fax:701-356-7993
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES NORTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50850Medicaid