Provider Demographics
NPI:1952679318
Name:VILLAGE FAMILY SERVICE CENTER
Entity Type:Organization
Organization Name:VILLAGE FAMILY SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-451-4900
Mailing Address - Street 1:1201 25TH ST S
Mailing Address - Street 2:PO BOX 9859
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2311
Mailing Address - Country:US
Mailing Address - Phone:701-451-4900
Mailing Address - Fax:701-451-4891
Practice Address - Street 1:2701 12TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8753
Practice Address - Country:US
Practice Address - Phone:701-293-3384
Practice Address - Fax:701-293-3384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST STEP RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-13
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1142101YA0400X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3Z71FIOtherUBH
MN8441481OtherBCBSMN