Provider Demographics
NPI:1215026117
Name:WEST RIVER HEALTH SERVICES
Entity Type:Organization
Organization Name:WEST RIVER HEALTH SERVICES
Other - Org Name:WEST RIVER HOME MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-567-6184
Mailing Address - Street 1:1000 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-7530
Mailing Address - Country:US
Mailing Address - Phone:701-567-4561
Mailing Address - Fax:701-567-6361
Practice Address - Street 1:1000 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639-7530
Practice Address - Country:US
Practice Address - Phone:701-567-6086
Practice Address - Fax:701-567-6365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST RIVER HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND57965Medicaid
SD9161510Medicaid
ND7241OtherBLUE CROSS OF NORTH DAKOT
ND57965Medicaid