Healthcare Provider Details

I. General information

NPI: 1508924622
Provider Name (Legal Business Name): LUTHERAN CHARITY ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 20TH ST SW
JAMESTOWN ND
58401-6201
US

IV. Provider business mailing address

2422 20TH ST SW
JAMESTOWN ND
58401-6201
US

V. Phone/Fax

Practice location:
  • Phone: 701-952-4820
  • Fax: 701-952-3263
Mailing address:
  • Phone: 701-952-4820
  • Fax: 701-952-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number173
License Number StateND

VIII. Authorized Official

Name: MICHAEL J DELFS
Title or Position: CEO
Credential:
Phone: 701-952-4850