Organization
FARGO MAPLE VIEW LLC
Active
Other names
Maple View Fargo
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD MICHAEL OLSON (CFO)
(701) 852-7700
Entity
Organization
Contact information
Practice address
4552 36TH AVE S, FARGO, ND 58104-5211
(701) 478-8655
Mailing address
4552 36TH AVE S, FARGO, ND 58104-5211
(701) 478-8655
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1461620
—
ND
Enumeration date
10/08/2020
Last updated
10/08/2020
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