Organization
PRAIRIE ST. JOHN'S, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS EIDE (CFO)
(701) 476-7200
Entity
Organization
Contact information
Practice address
510 4TH ST. SOUTH, FARGO, ND 58103
(401) 478-7517
(701) 478-7524
Mailing address
510 4TH ST. SOUTH, FARGO, ND 58103
(401) 478-7517
(701) 478-7524
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
597-1-1-08A
ND
Other
Enumeration date
02/05/2009
Last updated
02/05/2009
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