Healthcare Provider Details

I. General information

NPI: 1831365519
Provider Name (Legal Business Name): ELBOWOODS MEMORIAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 ELBOWOODS LOOP
NEW TOWN ND
58763
US

IV. Provider business mailing address

1251 ELBOWOODS LOOP
NEW TOWN ND
58763
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4750
  • Fax: 701-627-2809
Mailing address:
  • Phone: 701-627-4750
  • Fax: 701-627-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN EAGLE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 701-627-4750