Provider Demographics
NPI:1407436173
Name:ENTWINE, LLC
Entity type:Organization
Organization Name:ENTWINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-532-0991
Mailing Address - Street 1:4342 15TH AVE S STE 103
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1125
Mailing Address - Country:US
Mailing Address - Phone:701-532-0991
Mailing Address - Fax:701-532-0428
Practice Address - Street 1:4342 15TH AVE S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1125
Practice Address - Country:US
Practice Address - Phone:701-532-0991
Practice Address - Fax:701-532-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2023-11-13
Deactivation Date:2023-09-07
Deactivation Code:
Reactivation Date:2023-11-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty