Healthcare Provider Details

I. General information

NPI: 1063401867
Provider Name (Legal Business Name): NORTHWOOD DEACONESS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 N PARK ST
NORTHWOOD ND
58267-4102
US

IV. Provider business mailing address

PO BOX 190 4 N. PARK ST.
NORTHWOOD ND
58267-0190
US

V. Phone/Fax

Practice location:
  • Phone: 701-587-6459
  • Fax: 701-587-6479
Mailing address:
  • Phone: 701-587-6459
  • Fax: 701-587-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1045A
License Number StateND

VIII. Authorized Official

Name: PETE L ANTONSON
Title or Position: CEO
Credential: CPA
Phone: 701-587-6459