Healthcare Provider Details

I. General information

NPI: 1417093949
Provider Name (Legal Business Name): PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MOUNTAIN ST E
CAVALIER ND
58220-4015
US

IV. Provider business mailing address

PO BOX 380
CAVALIER ND
58220-0380
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-6307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA R LETEXIER
Title or Position: CEO
Credential: CEO
Phone: 701-265-6228