Organization
SPHERALIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH IVANOV QDDP (CEO)
(818) 300-6430
Entity
Organization
Contact information
Practice address
3120 33RD ST S APT 202, FARGO, ND 58103-7830
(818) 300-6430
Mailing address
3120 33RD ST S APT 202, FARGO, ND 58103-7830
(818) 300-6430
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
302R00000X
Health Maintenance Organization
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
08/28/2025
Last updated
08/28/2025
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