Provider Demographics
NPI:1184720864
Name:KIDDER COUNTY DISTRICT HEALTH UNIT
Entity type:Organization
Organization Name:KIDDER COUNTY DISTRICT HEALTH UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-475-2582
Mailing Address - Street 1:422 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:STEELE
Mailing Address - State:ND
Mailing Address - Zip Code:58482-7320
Mailing Address - Country:US
Mailing Address - Phone:701-475-2582
Mailing Address - Fax:701-475-2652
Practice Address - Street 1:422 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:STEELE
Practice Address - State:ND
Practice Address - Zip Code:58482-7320
Practice Address - Country:US
Practice Address - Phone:701-475-2582
Practice Address - Fax:701-475-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND57994Medicaid
ND57994Medicaid