Healthcare Provider Details

I. General information

NPI: 1255469631
Provider Name (Legal Business Name): COUNTY OF SARGENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MAIN STREET
FORMAN ND
58032
US

IV. Provider business mailing address

316 MAIN STREET
FORMAN ND
58032
US

V. Phone/Fax

Practice location:
  • Phone: 701-724-3725
  • Fax: 701-724-3296
Mailing address:
  • Phone: 701-724-3725
  • Fax: 701-724-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRENDA KAY PETERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-724-3725