SOUTHEAST HUMAN SERVICE CENTER (NPI# 1245284850) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245284850 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST HUMAN SERVICE CENTER |
| Practice Address |
2624 9th Ave S Fargo ND 58103-2350 |
| Practice Telephone | 7012984500 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CANDACE CAE FUGLESTEN (DIRECTOR) |
| Authorized Official Telephone | 7012984500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 032318 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295256386 | Southeast Human Service Center | Community/Behavioral Health | 2624 9th Ave S, Fargo, ND 58103-2350 | 2017-06-29 |
| 1932146941 | Southeast Human Service Center | Clinic/Center | 2624 9th Ave S, Fargo, ND 58103-2350 | 2006-05-31 |
| 1922055243 | Southeast Human Service Center | Day Training, Developmentally Disabled Services | 2624 9th Ave S, Fargo, ND 58103-2350 | 2006-05-30 |
| Street Address |
2624 9TH AVE S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-2350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750982120 | Lena Fogel | Counselor | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-11-03 |
| 1356956247 | Carmen Berg | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-09-09 |
| 1225643125 | Heidi Ottmar | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-09-09 |
| 1962011239 | Tayler Wilson | Registered Nurse | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-23 |
| 1023626595 | Jordan Solheim | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-21 |
| 1710595954 | Carissa Bertsch | Registered Nurse | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-14 |
| 1740898923 | Madeline Swanson | Social Worker | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-14 |
| 1821615394 | Tanner Valnes | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-01 |
| 1447876446 | Rachael Steinke | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-06-25 |
| 1346866506 | Baboucarr Jallow | Registered Nurse | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-06-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457521155 | Tri City Cares, Inc | Clinic/Center | 15 1st St Se, Stanley, ND 58784 | 2008-03-10 |
| 1821268517 | Tri City Care, Inc | Clinic/Center | 723 1st St Sw, Stanley, ND 58784 | 2008-03-10 |
| 1669642369 | Tri City Cares, Inc | Clinic/Center | 415 7th Ave Se, Stanley, ND 58784 | 2008-03-10 |
| 1982800959 | Tri City Cares, Inc. | Clinic/Center | 15 1st Street Se, Stanley, ND 58784 | 2007-06-26 |
| 1730212325 | Children's Development Center, Inc. | Clinic/Center | 1815 Schafer St, Ste 202, Bismarck, ND 58501-1217 | 2007-03-13 |
| 1194778944 | South Central Human Service Center | Clinic/Center | 520 3rd St Nw, Jamestown, ND 58401-2968 | 2006-05-19 |
| 1205293537 | Jmb Services Inc | Clinic/Center | 1911 N 11th St, Bismarck, ND 58501-1915 | 2016-01-17 |
| 1336454438 | Susan Delap, Md, Professional Corporation | Clinic/Center | 4023 State St, Suite 100, Bismarck, ND 58503-0690 | 2010-08-12 |
| 1902076607 | Tri City Care, Inc | Clinic/Center | 15 1st Ave Se, Stanley, ND 58784-9998 | 2008-03-10 |
| 1285804906 | Tri City Care, Inc | Clinic/Center | 15 1st St Se, Stanley, ND 58784 | 2008-03-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.