Provider Demographics
NPI:1346339850
Name:ALTRU HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALTRU HEALTH SYSTEM
Other - Org Name:ALTRU HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-780-1470
Mailing Address - Street 1:PO BOX 13780
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58208-3780
Mailing Address - Country:US
Mailing Address - Phone:701-780-5888
Mailing Address - Fax:
Practice Address - Street 1:2401 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4183
Practice Address - Country:US
Practice Address - Phone:701-780-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4018A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND357014Medicare Oscar/Certification
35-7014Medicare ID - Type Unspecified