Organization
LIGHTHOUSE CHURCH OF FARGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELINDA FAYE SCHNASE (ADMINISTRATIVE ASSISTANT)
(701) 212-8626
Entity
Organization
Contact information
Practice address
111 9TH ST S, FARGO, ND 58103-1831
(701) 212-8626
Mailing address
21 9TH ST S, FARGO, ND 58103-1830
(791) 212-8626
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251B00000X
—
ND
05
—
251S00000X
—
ND
05
—
347C00000X
—
ND
Enumeration date
02/24/2021
Last updated
02/24/2021
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