SHAREHOUSE GENESIS (NPI# 1356576979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356576979 |
| Entity Type | Organization |
| Organization Name | SHAREHOUSE GENESIS |
| Practice Address |
505 40th St S Unit B Fargo ND 58103-1184 |
| Mailing Address |
4227 9th Ave S Fargo ND 58103-2018 |
| Practice Telephone | 7014788440 |
| Practice Fax Number | 6519250046 |
| Mailing Telephone | 7012826561 |
| Mailing Fax Number | 6519250046 |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2020-09-23 |
| Authorized Official Name | MR. TYREL HEGLAND (PRESIDENT/CEO) |
| Authorized Official Telephone | 7012826561 |
| Is Organization Subpart | Y |
| Parent Organization Name | SHAREHOUSE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1056 | ND | Residential Treatment Facilities |
| Street Address |
505 40TH ST S UNIT B |
| City | FARGO |
| State | ND |
| Zip Code | 58103-1184 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144829334 | Sheryl Rae Mears | Social Worker | 505 40th St S Unit B, Fargo, ND 58103-1184 | 2020-10-20 |
| 1669071858 | Chad Ray Fischer | Social Worker | 505 40th St S Unit B, Fargo, ND 58103-1184 | 2020-10-20 |
| 1316556426 | Richard K Harvala Jr. | Counselor | 505 40th St S Unit B, Fargo, ND 58103-1184 | 2020-07-24 |
| 1821559907 | David Charles Laughlin | Social Worker | 505 40th St S Unit B, Fargo, ND 58103-1184 | 2019-03-29 |
| 1073024873 | Amy Caroline Noer | Counselor | 505 40th St S Unit B, Fargo, ND 58103-1184 | 2017-10-19 |
| 1780955641 | Jessica Kriel | Counselor | 505 40th St S Unit B, Fargo, ND 58103-1184 | 2012-01-24 |
| 1811274038 | Jeremy Traen | Counselor | 505 40th St S Unit B, Fargo, ND 58103-1184 | 2011-11-16 |
| 1952636706 | David Collins | Counselor | 505 40th St S Unit B, Fargo, ND 58103-1184 | 2009-10-13 |
| 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 | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598079394 | Jessica Ann Brown | Substance Abuse Rehabilitation Facility | 1202 23rd St S, Fargo, ND 58103-2951 | 2010-08-04 |
| 1366681918 | Prairie St. John's, LLC | Substance Abuse Rehabilitation Facility | 510 4th St. South, Fargo, ND 58103 | 2009-02-05 |
| 1619035276 | Sister's Path | Substance Abuse Rehabilitation Facility | 4219 9th Ave S, Fargo, ND 58103-2018 | 2006-12-05 |
| 1205903481 | Sharehouse, Inc. | Substance Abuse Rehabilitation Facility | 4227 9th Ave S, Fargo, ND 58103-2018 | 2006-11-30 |
| 1437537602 | Sharehouse, Inc | Substance Abuse Rehabilitation Facility | 4215 9th Ave S, Fargo, ND 58103-2018 | 2015-05-08 |
| 1639356983 | Sharehouse, Inc-partial Hospital Program | Substance Abuse Rehabilitation Facility | 4227 9th Ave Sw, Fargo, ND 58103-2018 | 2008-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730703984 | Turtle Mountain Band of Chippewa Indians | Substance Abuse Rehabilitation Facility | 1105 Sheldon Souray Avenue, Belcourt, ND 58316-0520 | 2020-06-03 |
| 1306308101 | Summit Silver Creek, LLC | Substance Abuse Rehabilitation Facility | 2046 125th Ave, Watford City, ND 58854 | 2019-04-02 |
| 1447736780 | Advance In Recovery, Pllc | Substance Abuse Rehabilitation Facility | 1206 Main St, Carrington, ND 58421-1902 | 2018-07-18 |
| 1003367103 | Medicine Horse Counseling, Pllc | Substance Abuse Rehabilitation Facility | 10435 63rd Ave Ne, Rocklake, ND 58365-9517 | 2016-10-24 |
| 1255656765 | Transitional Living Center Inc | Substance Abuse Rehabilitation Facility | 4399 88th Ave Ne, Devils Lake, ND 58301-8704 | 2010-03-29 |
| 1235452921 | New Beginnings Recovery Center | Substance Abuse Rehabilitation Facility | 693 5th Ave Sw, Dickinson, ND 58601-5808 | 2010-03-09 |
| 1265660187 | West Central Human Service Center | Substance Abuse Rehabilitation Facility | 412 Birchwood Dr, Bismarck, ND 58504-6209 | 2009-06-30 |
| 1437283587 | New Freedom Center | Substance Abuse Rehabilitation Facility | 905 E Interstate Ave, Bismarck, ND 58503-0549 | 2007-03-14 |
| 1730141763 | Family Recovery Home | Substance Abuse Rehabilitation Facility | 126 W Broadway, Williston, ND 58801-6053 | 2006-04-05 |
| 1831715002 | Summit Prairie Recovery Center | Substance Abuse Rehabilitation Facility | 7785 Saint Gertrude Ave, Raleigh, ND 58564-4103 | 2020-06-23 |
| Find all providers with the same taxonomy | ||||
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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.