Healthcare Provider Details

I. General information

NPI: 1730306812
Provider Name (Legal Business Name): HAZEN MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number6016A
License Number StateND

VIII. Authorized Official

Name: KURT WALDBILLIG
Title or Position: DIRECTOR
Credential: RN
Phone: 701-748-2225