Healthcare Provider Details

I. General information

NPI: 1245078823
Provider Name (Legal Business Name): SERVICE FIRST HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 32ND ST E APT 203
WILLISTON ND
58801-5083
US

IV. Provider business mailing address

215 32ND ST E APT 203
WILLISTON ND
58801-5083
US

V. Phone/Fax

Practice location:
  • Phone: 404-985-7025
  • Fax:
Mailing address:
  • Phone: 404-985-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MISS JOLIE IPONDO AKUMBY
Title or Position: LPN
Credential: NURSE
Phone: 404-985-7025