Organization
ST. SOPHIE'S, LLC
Active
Organization
ST. SOPHIE'S, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMMET MICHAEL KENNEY JR. MD (PRESIDENT/CEO)
(701) 365-4488
Entity
Organization
Contact information
Practice address
5045 E COTTONTAIL RUN RD, PARADISE VALLEY, AZ 85253-3316
(701) 365-4488
(701) 365-4127
Mailing address
3120Z 25TH ST S # 340, FARGO, ND 58103-5054
(701) 365-4488
(701) 365-4127
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
7174
ND
261QM0855X
Adolescent and Children Mental Health Clinic/Center
7174
ND
Other
Enumeration date
03/28/2012
Last updated
03/28/2012
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