Provider Demographics
NPI:1689390999
Name:CATHOLIC CHARITIES NORTH DAKOTA
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES NORTH DAKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:DELRAE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-371-6166
Mailing Address - Street 1:5201 BISHOPS BLVD S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7605
Mailing Address - Country:US
Mailing Address - Phone:701-356-8037
Mailing Address - Fax:701-866-3015
Practice Address - Street 1:209 10TH AVE
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2436
Practice Address - Country:US
Practice Address - Phone:701-256-2354
Practice Address - Fax:701-256-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND58249OtherZIP CODE