Organization
ST. WILL'S, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMMET MICHAEL KENNEY JR. M.D. (PRESIDENT)
(701) 577-5700
Entity
Organization
Contact information
Practice address
3137 32ND AVE S, SUITE 223, FARGO, ND 58103-6159
(701) 577-5700
Mailing address
3137 32ND AVE S, SUITE 223, FARGO, ND 58103-6159
(701) 577-5700
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
7174
ND
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
7174
ND
Other
Enumeration date
01/06/2011
Last updated
03/15/2011
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