Healthcare Provider Details

I. General information

NPI: 1306850706
Provider Name (Legal Business Name): P R HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 VIVIAN ST.
PARK RIVER ND
58270-4540
US

IV. Provider business mailing address

PO BOX I 115 VIVIAN ST.
PARK RIVER ND
58270-0708
US

V. Phone/Fax

Practice location:
  • Phone: 701-284-7555
  • Fax: 701-284-4605
Mailing address:
  • Phone: 701-284-7555
  • Fax: 701-284-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LOUISE DRYBURGH
Title or Position: CEO
Credential:
Phone: 701-284-7500