Healthcare Provider Details

I. General information

NPI: 1184722969
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: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTH PARK STREET
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 Code314000000X
TaxonomySkilled Nursing Facility
License Number1045A
License Number StateND

VIII. Authorized Official

Name: MR. PETE ANTONSON
Title or Position: ADMINISTRATOR
Credential: CEO
Phone: 701-587-6060