Provider Demographics
NPI:1730306812
Name:HAZEN MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:HAZEN MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:SAKAKAWEA MEDICAL CENTER HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDBILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:701-748-2225
Mailing Address - Street 1:510 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-4637
Mailing Address - Country:US
Mailing Address - Phone:701-748-7380
Mailing Address - Fax:
Practice Address - Street 1:510 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-4637
Practice Address - Country:US
Practice Address - Phone:701-748-7380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAZEN MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6016A251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50199Medicaid
ND50199Medicaid