PRAIRIE ST. JOHN'S, LLC
NPI 1366681918
Substance Abuse Rehabilitation Facility in Fargo, ND

Q: What is Prairie St. John's, LLC's NPI number?

The NPI number for Prairie St. John's, LLC is 1366681918. It was assigned to this organization in the NPPES registry on February 5, 2009.

Q: What is Prairie St. John's, LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Active since February 05, 2009CLIA 35D0951705 · Waiver

510 4TH ST. SOUTH, FARGO, ND 58103(401) 478-7517(701) 478-7524 Get Directions Write a Review

NPPES record last updated: February 5, 2009. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Prairie St. John's, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRAIRIE ST. JOHN'S, LLC (NPI 1366681918) is a healthcare organization registered as a substance abuse rehabilitation facility in Fargo, North Dakota and active in the NPI registry since February 2009. The organization holds a CLIA Waiver certificate valid through August 31, 2027 and lists Thomas Eide, Cfo, as its authorized official.

NPPES Registry Identity

NPI1366681918

Entity TypeOrganization

Primary Taxonomy324500000X

Legal Business NamePRAIRIE ST. JOHN'S, LLC

Location Address510 4TH ST. SOUTHFargo, ND 58103

Mailing Address510 4th St. SouthFargo, ND 58103 · (401) 478-7517 · Fax (701) 478-7524

Phone(401) 478-7517

Fax(701) 478-7524

Organization SubpartNo

Authorized OfficialThomas EideCfo · (701) 476-7200

Enumeration DateFebruary 5, 2009

✔ NPI 1366681918 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities

Taxonomy Code324500000X

License✔ Licensed in ND · 597-1-1-08A

Definition

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

510 4TH ST. SOUTH, Fargo, ND 58103

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 35D0951705

Psj Acquisition, LLC Dba Prairie St John's · Fargo, ND

Active · expires Aug 31, 2027

CLIA Number35D0951705

Laboratory TypeHospital

Certificate Effective DateSeptember 1, 2025

Certificate Expiration DateAugust 31, 2027

Laboratory DirectorKeith Breiland

Laboratory Phone(701) 476-7200

Laboratory LocationPsj Acquisition, LLC Dba Prairie St John's510 4th St S, Fargo, ND 58103

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Prairie St. John's, LLC's NPI number?

The NPI number for Prairie St. John's, LLC is 1366681918. It was assigned to this organization in the NPPES registry on February 5, 2009.

Where is Prairie St. John's, LLC located?

Prairie St. John's, LLC is located at 510 4th St. South, Fargo, ND 58103. The listed phone number is (401) 478-7517.

What is Prairie St. John's, LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Prairie St. John's, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 35D0951705) is associated with this NPI, valid through August 31, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Prairie St. John's, LLC was last updated on February 5, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.