Provider Demographics
NPI:1639837941
Name:PEOPLES RISING ACADEMY
Entity Type:Organization
Organization Name:PEOPLES RISING ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:PLECITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-541-0875
Mailing Address - Street 1:4779 63RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4502
Mailing Address - Country:US
Mailing Address - Phone:701-541-0875
Mailing Address - Fax:
Practice Address - Street 1:1383 21ST AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1841
Practice Address - Country:US
Practice Address - Phone:701-541-0875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization