Healthcare Provider Details

I. General information

NPI: 1578781324
Provider Name (Legal Business Name): HAZEN MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE
HAZEN ND
58545-4637
US

IV. Provider business mailing address

510 8TH AVE NE
HAZEN ND
58545-4637
US

V. Phone/Fax

Practice location:
  • Phone: 701-748-7380
  • Fax:
Mailing address:
  • Phone: 701-748-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4053A
License Number StateND

VIII. Authorized Official

Name: MR. DARROLD BERTSCH
Title or Position: CEO
Credential:
Phone: 701-748-7230