Provider Demographics
NPI:1255788949
Name:CHI HEALTH CONNECT AT HOME-FARGO
Entity type:Organization
Organization Name:CHI HEALTH CONNECT AT HOME-FARGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OPERATIONS/AUTH OFFICAL
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 1:4816 AMBER VALLEY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8404
Mailing Address - Country:US
Mailing Address - Phone:701-237-8116
Mailing Address - Fax:701-237-8188
Practice Address - Street 1:1310 E MAIN AVE STE 339
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4680
Practice Address - Country:US
Practice Address - Phone:701-530-4500
Practice Address - Fax:701-530-4572
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONSPIRIT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-23
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4037Medicaid
ND357016Medicare Oscar/Certification