SOUTHEAST HUMAN SERVICE CENTER


Address: 2624 9th Ave S, Fargo, ND 58103-2350
Phone: 7012984500

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QD1600X Clinic/Center
Specialization: Developmental Disabilities
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
ND 032318 05

Other Provider IDs and Locations

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

Office Location

Street Address 2624 9TH AVE S
City FARGO
State ND
Zip Code 58103-2350

Providers in the same location

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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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 261QD1600X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Developmental Disabilities

Taxonomy Definition

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]

Providers in the same taxonomy and state

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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Competitor

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City FARGO
Zip Code 58103

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Dataset Information

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.

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