Provider Demographics
NPI:1831365519
Name:ELBOWOODS MEMORIAL HEALTH CENTER
Entity type:Organization
Organization Name:ELBOWOODS MEMORIAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-627-4750
Mailing Address - Street 1:1251 ELBOWOODS LOOP
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763
Mailing Address - Country:US
Mailing Address - Phone:701-627-4750
Mailing Address - Fax:701-627-2809
Practice Address - Street 1:1251 ELBOWOODS LOOP
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763
Practice Address - Country:US
Practice Address - Phone:701-627-4750
Practice Address - Fax:701-627-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1463340Medicaid