Provider Demographics
NPI:1356449136
Name:NORTHWOOD DEACONESS HEALTH CENTER
Entity type:Organization
Organization Name:NORTHWOOD DEACONESS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-587-6060
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0190
Mailing Address - Country:US
Mailing Address - Phone:701-587-6060
Mailing Address - Fax:701-587-6492
Practice Address - Street 1:4 NORTH PARK ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-0190
Practice Address - Country:US
Practice Address - Phone:701-587-6060
Practice Address - Fax:701-587-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND35D0684526291U00000X
341600000X
ND5040P282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No291U00000XLaboratoriesClinical Medical Laboratory
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11827Medicaid
MN623348100Medicaid
NDD01045Medicaid
ND0174OtherBCBS
1000064OtherMEDICARE PART B
ND11827Medicaid
ND351312Medicare Oscar/Certification