Provider Demographics
NPI:1770506032
Name:WALHALLA COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:WALHALLA COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:PEMBILIER NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-549-3310
Mailing Address - Street 1:500 DELANO AVENUE
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282
Mailing Address - Country:US
Mailing Address - Phone:701-549-3831
Mailing Address - Fax:701-549-3833
Practice Address - Street 1:500 DELANO AVENUE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282
Practice Address - Country:US
Practice Address - Phone:701-549-3831
Practice Address - Fax:701-549-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1055A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1313OtherBLUE CROSS BLUE SHIELD
ND30035Medicaid
ND30035Medicaid