Provider Demographics
NPI:1790377448
Name:CHI HEALTH CONNECT AT HOME - FARGO
Entity Type:Organization
Organization Name:CHI HEALTH CONNECT AT HOME - FARGO
Other - Org Name:CHI HEALTH AT HOME-BISMARCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OPERATIONS/AUTH OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEYERL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-238-3206
Mailing Address - Street 1:4265 45TH ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4309
Mailing Address - Country:US
Mailing Address - Phone:888-538-0069
Mailing Address - Fax:
Practice Address - Street 1:1212 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4518
Practice Address - Country:US
Practice Address - Phone:701-530-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service