Provider Demographics
NPI:1336735752
Name:ADDIE'S ANGELS OF NORTH DAKOTA
Entity Type:Organization
Organization Name:ADDIE'S ANGELS OF NORTH DAKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-429-0320
Mailing Address - Street 1:1609 29TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5922
Mailing Address - Country:US
Mailing Address - Phone:701-429-0320
Mailing Address - Fax:
Practice Address - Street 1:1609 29TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5922
Practice Address - Country:US
Practice Address - Phone:701-429-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-19
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)