Provider Demographics
NPI:1720827876
Name:FRIENDS OF THE CHILDREN FARGO-MOORHEAD
Entity type:Organization
Organization Name:FRIENDS OF THE CHILDREN FARGO-MOORHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-799-0110
Mailing Address - Street 1:5183 44TH ST S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6069
Mailing Address - Country:US
Mailing Address - Phone:701-532-1465
Mailing Address - Fax:
Practice Address - Street 1:1111 WESTRAC DR S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2384
Practice Address - Country:US
Practice Address - Phone:701-532-1465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable