Healthcare Provider Details

I. General information

NPI: 1760542500
Provider Name (Legal Business Name): PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
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
US

IV. Provider business mailing address

301 MOUNTAIN STREET
CAVALIER ND
58220
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-8473
  • Fax: 701-265-6269
Mailing address:
  • Phone: 701-265-8473
  • Fax: 701-265-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5009B
License Number StateND

VIII. Authorized Official

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