Organization
COMMUNITY UPLIFT PROGRAM
Active
Parent organization
COMMUNITY UPLIFT PROGRAM
Other names
Harbor Health Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY UPLIFT PROGRAM
Authorized official
CODY SEVERSON (EXECUTIVE DIRECTOR)
(701) 639-3094
Entity
Organization
Contact information
Practice address
417 MAIN AVE STE 401, FARGO, ND 58103-1956
(701) 799-7314
Mailing address
PO BOX 909, FARGO, ND 58107-0909
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/07/2018
Last updated
10/12/2018
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