Provider Demographics
NPI:1679669741
Name:P R HEALTH CORPORATION
Entity Type:Organization
Organization Name:P R HEALTH CORPORATION
Other - Org Name:FIRST CARE HEALTH CENTER
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:P O 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:701-284-7500
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:701-284-7500
Practice Address - Fax:701-284-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5042P282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDD01047Medicaid
ND351326Medicare ID - Type Unspecified