Provider Demographics
NPI:1972626216
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEWBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-532-3401
Mailing Address - Street 1:2506 35TH AVE S
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:701-235-0971
Mailing Address - Fax:701-235-1051
Practice Address - Street 1:821 WESTERN RD
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075
Practice Address - Country:US
Practice Address - Phone:701-235-0971
Practice Address - Fax:701-235-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND30865315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND003200006Medicaid