| Lutheran Social Services Of Nd | |
|
3911 20th Ave S Fargo ND 58103 | |
| (701) 235-7341 | |
| Not Available |
| Full Name | Lutheran Social Services Of Nd |
|---|---|
| Speciality | Psychiatric Residential Treatment Facility |
| Location | 3911 20th Ave S, Fargo, North Dakota |
| Authorized Official Name and Position | Jessica Thommason (PRESIDENT CEO) |
| Authorized Official Contact | 7012357341 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lutheran Social Services Of Nd Po Box 389 Fargo ND 58107-0389 Ph: (701) 235-7341 | Lutheran Social Services Of Nd 3911 20th Ave S Fargo ND 58103 Ph: (701) 235-7341 |
| NPI Number | 1356558878 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 04/03/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356558878 | NPI | - | NPPES |
| 050955 | Medicaid | ND | |
| 55350 | Medicaid | ND | |
| 57446 | Medicaid | ND | |
| 54635 | Medicaid | ND | |
| 0005817398 | Other | AETNA | |
| 10355 | Other | ND | BLUE CROSS BLUE SHIELD ND |
| 50-50094 | Other | MEDICA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 323P00000X | Psychiatric Residential Treatment Facility | (* (Not Available)) | Primary |
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