Provider Demographics
NPI:1942800263
Name:RED RIVER HUMAN SERVICES FOUNDATION
Entity Type:Organization
Organization Name:RED RIVER HUMAN SERVICES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:701-532-3402
Mailing Address - Street 1:2506 35TH AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8897
Mailing Address - Country:US
Mailing Address - Phone:701-532-3402
Mailing Address - Fax:701-235-1051
Practice Address - Street 1:808 6TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4801
Practice Address - Country:US
Practice Address - Phone:701-591-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455775Medicaid