Healthcare Provider Details

I. General information

NPI: 1356312227
Provider Name (Legal Business Name): MERCY HOSPITAL OF DEVILS LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 7TH ST NE
DEVILS LAKE ND
58301-2798
US

IV. Provider business mailing address

1031 7TH STREET NE
DEVILS LAKE ND
58301-2798
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2131
  • Fax: 701-662-9651
Mailing address:
  • Phone: 701-662-2131
  • Fax: 701-662-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4009A
License Number StateND

VIII. Authorized Official

Name: MR. MICHAEL J LOFF
Title or Position: CFO
Credential:
Phone: 701-662-2131