Provider Demographics
NPI:1225457864
Name:NORTHWOOD DEACONESS HEALTH CENTER
Entity Type:Organization
Organization Name:NORTHWOOD DEACONESS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KJORVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-587-6434
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0190
Mailing Address - Country:US
Mailing Address - Phone:701-587-6060
Mailing Address - Fax:701-587-6479
Practice Address - Street 1:4 N PARK ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-4102
Practice Address - Country:US
Practice Address - Phone:701-587-6060
Practice Address - Fax:701-587-6479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWOOD DEACONESS HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-10
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8090311Z00000X
ND5040332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies