Provider Demographics
NPI:1801995402
Name:COUNTY OF PEMBINA
Entity type:Organization
Organization Name:COUNTY OF PEMBINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:701-265-4248
Mailing Address - Street 1:301 DAKOTA ST W UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-4100
Mailing Address - Country:US
Mailing Address - Phone:701-265-4248
Mailing Address - Fax:701-265-5193
Practice Address - Street 1:301 DAKOTA ST W UNIT 2
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-4100
Practice Address - Country:US
Practice Address - Phone:701-265-4248
Practice Address - Fax:701-265-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND29251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4560002230OtherTAX ID