Healthcare Provider Details

I. General information

NPI: 1073665493
Provider Name (Legal Business Name): SPIRIT LAKE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 74TH AVE NE
FORT TOTTEN ND
58335-0309
US

IV. Provider business mailing address

3883 74TH AVE NE PO BOX 309
FORT TOTTEN ND
58335-0309
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-1600
  • Fax:
Mailing address:
  • Phone: 701-766-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateND

VIII. Authorized Official

Name: ARLENE M KRULISH
Title or Position: CEO
Credential:
Phone: 701-766-1600