Healthcare Provider Details

I. General information

NPI: 1831595487
Provider Name (Legal Business Name): CAVALIER COUNTY SENIOR MEALS & SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 8TH AVE
LANGDON ND
58249-2637
US

IV. Provider business mailing address

211 8TH AVE
LANGDON ND
58249-2637
US

V. Phone/Fax

Practice location:
  • Phone: 701-256-2828
  • Fax: 701-256-2838
Mailing address:
  • Phone: 701-256-2828
  • Fax: 701-256-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License NumberKDJ239
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License NumberG11306
License Number StateND

VIII. Authorized Official

Name: KARRIE LYNN MIKKELSEN
Title or Position: DIRECTOR
Credential:
Phone: 701-256-2828