Healthcare Provider Details

I. General information

NPI: 1811581820
Provider Name (Legal Business Name): NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 07/14/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 FOUSSARD AVE NW
ST JOHN ND
58369
US

IV. Provider business mailing address

PO BOX 535
TURTLE LAKE ND
58575-0535
US

V. Phone/Fax

Practice location:
  • Phone: 701-448-2054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RACHEL THOMAS
Title or Position: CFO
Credential:
Phone: 701-448-2054