Provider Demographics
NPI:1366293458
Name:EMERALD CARES
Entity type:Organization
Organization Name:EMERALD CARES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TEHTEE
Authorized Official - Middle Name:KOU
Authorized Official - Last Name:PAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-683-5125
Mailing Address - Street 1:15 21ST ST S STE 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1435
Mailing Address - Country:US
Mailing Address - Phone:701-347-1516
Mailing Address - Fax:701-540-0421
Practice Address - Street 1:15 21ST ST S STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1435
Practice Address - Country:US
Practice Address - Phone:701-347-1516
Practice Address - Fax:701-540-0421
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERALD CARES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health