Provider Demographics
NPI:1891563938
Name:GRATITUDE HOLISTIC SERVICES LLC
Entity Type:Organization
Organization Name:GRATITUDE HOLISTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:TAH
Authorized Official - Last Name:TAMUNANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:701-200-5423
Mailing Address - Street 1:6828 24TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7805
Mailing Address - Country:US
Mailing Address - Phone:701-200-5423
Mailing Address - Fax:
Practice Address - Street 1:6828 24TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7805
Practice Address - Country:US
Practice Address - Phone:701-200-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health