Healthcare Provider Details

I. General information

NPI: 1578878047
Provider Name (Legal Business Name): CHI HEALTH CONNECT AT HOME-FARGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 2ND AVENUE WEST
DICKINSON ND
58601-3916
US

IV. Provider business mailing address

4265 45TH ST S STE 200
FARGO ND
58104-4309
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4378
  • Fax: 701-456-4809
Mailing address:
  • Phone: 701-237-8116
  • Fax: 701-237-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number6005
License Number StateND

VIII. Authorized Official

Name: NICOLE PEYERL
Title or Position: DIRECTOR OPERATIONS/AUTH OFFICIAL
Credential:
Phone: 701-238-3206