# COMMUNITY UPLIFT PROGRAM

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COMMUNITY UPLIFT PROGRAM
- **Other names:** Harbor Health Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1538661384
- **Legal business name:** COMMUNITY UPLIFT PROGRAM
- **Authorized official:** CODY SEVERSON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (701) 639-3094

## Contact information

- **Practice address:** 417 MAIN AVE STE 401, FARGO, ND 58103-1956
- **Practice address phone:** (701) 799-7314
- **Mailing address:** PO BOX 909, FARGO, ND 58107-0909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/07/2018
- **Last updated:** 10/12/2018