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PRAIRIE ST JOHNS
NPI 1417901000
Psychiatric Hospital in Fargo, ND

Active since May 19, 2006
510 4TH ST S, FARGO, ND 58103(701) 476-7200(701) 476-7261 Get Directions Write a Review

NPPES record last updated: May 22, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Prairie St Johns NPPES

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

PRAIRIE ST JOHNS (NPI 1417901000), doing business as Childrens Psychiatric Hospital, is a healthcare organization registered as a psychiatric hospital in Fargo, North Dakota and active in the NPI registry since May 2006. The organization lists Emmet M Kenney, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1417901000
Entity TypeOrganization
Primary Taxonomy283Q00000X
Legal Business NamePRAIRIE ST JOHNS
Location Address510 4TH ST SFargo, ND 58103-1914
Mailing Address510 4th St SFargo, ND 58103-1914 · (701) 476-7200 · Fax (701) 476-7261
Phone(701) 476-7200
Fax(701) 476-7261
Organization SubpartNo
Authorized OfficialEmmet M KenneyChief Executive Officer · (701) 476-7882
Enumeration DateMay 19, 2006
Last NPPES UpdateMay 22, 2008
✔ NPI 1417901000 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatric HospitalHospitals
Taxonomy Code283Q00000X
Licenses✔ Licensed in ND · 5063A✔ Licensed in MN · 1567
Definition
An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.
510 4TH ST S, Fargo, ND 58103
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Other Names 1

Former Legal Business NameChildrens Psychiatric Hospital

Other Identifiers 7

Medicare ID-Type Unspecified71130ND
Medicare ID-Type UnspecifiedC03146MN
Medicaid11778ND
Medicaid99725100MN
Medicare PIN71130ND
Medicaid099725100MN
Medicare UPINC03146MN

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KIFF ELIZABETH PETERSON
Nurse Practitioner (Psychiatric/Mental Health)
510 4TH ST S
FARGO, ND 58103
Cass County (701) 476-7200
ASHLEY BISHOP
Nurse Practitioner (Psychiatric/Mental Health)
510 4TH ST S
FARGO, ND 58103
Cass County (701) 476-7200
DR. LAWANA MARIE BURTNETT M.D.
Psychiatry & Neurology (Psychiatry)
510 4TH ST S
FARGO, ND 58103
Cass County (701) 476-7200
MARYN LYNNA YOUNG FNP-BC, PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
510 4TH ST S
FARGO, ND 58103
Cass County (701) 476-7200
CHERYL MELBYE LAC
Counselor (Addiction (Substance Use Disorder))
510 4TH ST S
FARGO, ND 58103
Cass County (701) 476-7240
MRS. GLENICE M CARLSON PAC
Physician Assistant
510 4TH ST S, PRAIRIE ST JOHNS
FARGO, ND 58103
Cass County (701) 476-7239
CAMIE LYNN PFEIFER LAC
Counselor (Addiction (Substance Use Disorder))
510 4TH ST S
FARGO, ND 58103
Cass County (701) 476-7876
WILLIAM D BRINK LAC
Counselor (Addiction (Substance Use Disorder))
510 4TH ST S
FARGO, ND 58103
Cass County (701) 476-7200

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 Johns's NPI number?

The NPI number for Prairie St Johns is 1417901000. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider was formerly known as Childrens Psychiatric Hospital.

Where is Prairie St Johns located?

Prairie St Johns is located at 510 4th St S, Fargo, ND 58103. The listed phone number is (701) 476-7200.

What is Prairie St Johns's specialty?

The primary specialty registered for this NPI is Psychiatric Hospital with taxonomy code 283Q00000X.

When was this NPI record last updated?

The NPPES record for Prairie St Johns was last updated on May 22, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.