Organization
SOUTHEAST HUMAN SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE CAE FUGLESTEN (DIRECTOR)
(701) 298-4500
Entity
Organization
Contact information
Practice address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
Mailing address
2624 9TH AVE S, FARGO, ND 58103-2350
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035434
—
ND
Enumeration date
05/30/2006
Last updated
08/22/2020
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