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

Active since February 05, 2009CLIA Certified · 4 labs
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: August 02, 2026.

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 4 active CLIA laboratory certificates 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 4

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.

Certificate of Waiver 35D2083003

Prairie St John's · Fargo, ND
Active · expires Aug 25, 2026
CLIA Number35D2083003
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateAugust 26, 2024
Certificate Expiration DateAugust 25, 2026
Laboratory DirectorDr. Eric C. Tee
Laboratory Phone(701) 476-7200
Laboratory LocationPrairie St John'sSt Michaels 340 6th Ave S, Fargo, ND 58103
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 35D2083007

Prairie St John's · Fargo, ND
Active · expires Aug 25, 2026
CLIA Number35D2083007
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateAugust 26, 2024
Certificate Expiration DateAugust 25, 2026
Laboratory DirectorDr. Eric C. Tee
Laboratory Phone(701) 476-7200
Laboratory LocationPrairie St John'sSaint Stephens 334 6th Ave S, Fargo, ND 58103
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 35D2083008

Prairie St John's · Fargo, ND
Active · expires Aug 25, 2026
CLIA Number35D2083008
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateAugust 26, 2024
Certificate Expiration DateAugust 25, 2026
Laboratory DirectorKeith Breiland
Laboratory Phone(701) 476-7200
Laboratory LocationPrairie St John'sSaint Genevieve's Place 390 6th Ave S, Fargo, ND 58103
CLIA data matches this NPI record on: 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 CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

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.