Healthcare Provider Details

I. General information

NPI: 1356449136
Provider Name (Legal Business Name): NORTHWOOD DEACONESS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTH PARK ST
NORTHWOOD ND
58267-0190
US

IV. Provider business mailing address

PO BOX 190
NORTHWOOD ND
58267-0190
US

V. Phone/Fax

Practice location:
  • Phone: 701-587-6060
  • Fax: 701-587-6492
Mailing address:
  • Phone: 701-587-6060
  • Fax: 701-587-6492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5040P
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number35D0684526
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: BROCK SHERVA
Title or Position: CEO
Credential:
Phone: 701-587-6060