Organization
ST. SOPHIE'S, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY JEAN FREI (OFFICE MANAGER)
(701) 365-4467
Entity
Organization
Contact information
Practice address
3201 33RD ST S, FARGO, ND 58104-8823
(701) 365-4488
(701) 365-0727
Mailing address
3201 33RD ST S, FARGO, ND 58104-8823
(701) 365-4488
(701) 365-0727
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
7174
ND
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
7174
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15685
—
ND
Enumeration date
12/29/2010
Last updated
04/30/2014
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