Healthcare Provider Details

I. General information

NPI: 1174606271
Provider Name (Legal Business Name): WEST RIVER HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 12
HETTINGER ND
58639-7530
US

IV. Provider business mailing address

1000 HIGHWAY 12
HETTINGER ND
58639-7530
US

V. Phone/Fax

Practice location:
  • Phone: 701-567-4561
  • Fax: 701-567-6361
Mailing address:
  • Phone: 701-567-4561
  • Fax: 701-567-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALYSON KORNELE
Title or Position: CEO
Credential:
Phone: 701-567-6184