Provider Demographics
NPI:1679672646
Name:WALSH COUNTY HEALTH DISTRICT
Entity Type:Organization
Organization Name:WALSH COUNTY HEALTH DISTRICT
Other - Org Name:WALSH COUNTY HEALTH DEPT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KRATOCHVIL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:701-352-5139
Mailing Address - Street 1:638 COOPER AVE
Mailing Address - Street 2:ADMINISTRATION BLDG. SUITE 3
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1511
Mailing Address - Country:US
Mailing Address - Phone:701-352-5139
Mailing Address - Fax:701-352-5074
Practice Address - Street 1:638 COOPER AVE
Practice Address - Street 2:ADMINISTRATION BLDG. SUITE 3
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1511
Practice Address - Country:US
Practice Address - Phone:701-352-5139
Practice Address - Fax:701-352-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND57986Medicaid
ND57986Medicaid