Organization
PRAIRIE ST JOHNS
Active
Organization
PRAIRIE ST JOHNS
Active
Other names
Childrens Psychiatric Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
EMMET M KENNEY JR. MD (CHIEF EXECUTIVE OFFICER)
(701) 476-7882
Entity
Organization
Contact information
Practice address
510 4TH ST S, FARGO, ND 58103-1914
(701) 476-7200
(701) 476-7261
Mailing address
510 4TH ST S, FARGO, ND 58103-1914
(701) 476-7200
(701) 476-7261
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
1567
MN
283Q00000X
Psychiatric Hospital
Primary
5063A
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099725100
—
MN
05
—
11778
—
ND
05
—
99725100
—
MN
Enumeration date
05/19/2006
Last updated
05/22/2008
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