Provider Demographics
NPI:1306850706
Name:P R HEALTH CORPORATION
Entity Type:Organization
Organization Name:P R HEALTH CORPORATION
Other - Org Name:FIRST CARE RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRYBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-284-7500
Mailing Address - Street 1:PO BOX I
Mailing Address - Street 2:115 VIVIAN ST.
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-0708
Mailing Address - Country:US
Mailing Address - Phone:701-284-7555
Mailing Address - Fax:701-284-4605
Practice Address - Street 1:115 VIVIAN ST.
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-4540
Practice Address - Country:US
Practice Address - Phone:701-284-7555
Practice Address - Fax:701-284-4605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:P R HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDD05074Medicaid
NDD05074Medicaid
ND353405Medicare ID - Type Unspecified