Healthcare Provider Details

I. General information

NPI: 1558389338
Provider Name (Legal Business Name): CARRINGTON HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 5TH ST N
CARRINGTON ND
58421
US

IV. Provider business mailing address

820 5TH ST N PO BOX 79
CARRINGTON ND
58421-1223
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-2515
  • Fax: 701-652-3595
Mailing address:
  • Phone: 701-652-2515
  • Fax: 701-652-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number5008
License Number StateND

VIII. Authorized Official

Name: JAN A HENDERSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 402-328-2055