Healthcare Provider Details

I. General information

NPI: 1801995402
Provider Name (Legal Business Name): COUNTY OF PEMBINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DAKOTA ST W UNIT 2
CAVALIER ND
58220-4100
US

IV. Provider business mailing address

301 DAKOTA ST W UNIT 2
CAVALIER ND
58220-4100
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-4248
  • Fax: 701-265-5193
Mailing address:
  • Phone: 701-265-4248
  • Fax: 701-265-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number29
License Number StateND

VIII. Authorized Official

Name: JULIE K HARDY
Title or Position: DIRECTOR / ADMINISTRATOR
Credential: RN
Phone: 701-265-4248