Provider Demographics
NPI:1801907720
Name:CITY OF GRAND FORKS
Entity type:Organization
Organization Name:CITY OF GRAND FORKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-787-8100
Mailing Address - Street 1:151 S 4TH ST
Mailing Address - Street 2:SUITE N301
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4715
Mailing Address - Country:US
Mailing Address - Phone:701-787-8100
Mailing Address - Fax:701-787-8145
Practice Address - Street 1:151 S 4TH ST
Practice Address - Street 2:SUITE N301
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4715
Practice Address - Country:US
Practice Address - Phone:701-787-8100
Practice Address - Fax:701-787-8145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF GRAND FORKS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND600000426OtherPALMETTO GBA RAILROAD MED
ND57984Medicaid
NDN70473Medicare ID - Type UnspecifiedMEDICARE PART B