Provider Demographics
NPI:1053287706
Name:LEGEND MENTALITY
Entity type:Organization
Organization Name:LEGEND MENTALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:SERWA
Authorized Official - Last Name:AYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-970-0145
Mailing Address - Street 1:3547 47TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7767
Mailing Address - Country:US
Mailing Address - Phone:701-970-0667
Mailing Address - Fax:701-532-0698
Practice Address - Street 1:3547 47TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7767
Practice Address - Country:US
Practice Address - Phone:701-970-0667
Practice Address - Fax:701-532-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child