Organization
SHAREHOUSE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY JON CLARK LAC (ADDICTION COUNSELOR)
(701) 478-9551
Entity
Organization
Contact information
Practice address
4215 9TH AVE S, FARGO, ND 58103-2018
(701) 478-9554
Mailing address
4227 9TH AVE S, FARGO, ND 58103-2018
(701) 478-9554
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1744
ND
Other
Enumeration date
05/08/2015
Last updated
05/08/2015
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