Provider Demographics
NPI:1740224807
Name:NORTHERN ITASCA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NORTHERN ITASCA HOSPITAL DISTRICT
Other - Org Name:BIGFORK VALLEY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ODEGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-743-3177
Mailing Address - Street 1:258 PINE TREE DRIVE
Mailing Address - Street 2:P.O. BOX 258
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628
Mailing Address - Country:US
Mailing Address - Phone:218-743-3177
Mailing Address - Fax:218-743-3559
Practice Address - Street 1:258 PINE TREE DRIVE
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628
Practice Address - Country:US
Practice Address - Phone:218-743-3177
Practice Address - Fax:218-743-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330555251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1547ANOOtherBLUE CROSS
MN1018500OtherPREFERRED ONE
MN361259OtherHOSPICE
MN98592OtherARAZ
MN300410OtherUCARE
MN5900075OtherMEDICA CHOICE
MN2257OtherHEALTH PARTNERS
MN248065Medicare ID - Type Unspecified