MEDICARE: CHI HEALTH CONNECT AT HOME-FARGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency		ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639484140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHI HEALTH CONNECT AT HOME-FARGO

Provider Business Mailing Address
First Line	:	4265 45TH ST S STE 200
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-4309
Country	:	US
Telephone Number	:	701-237-8116
Fax Number	:	701-237-8188

Provider Business Practice Location Address
First Line	:	1301 15TH AVE W
Second Line	:
City	:	WILLISTON
State	:	ND
Zip	:	58801-3821
Country	:	US
Telephone Number	:	701-774-7430
Fax Number	:	701-774-7465

Authorized Official
Title or Position	:	DIRECTOR OPERATIONS/AUTH OFFICIAL
Name	:	NICOLE PEYERL
Credential	:
Telephone Number	:	701-238-3206

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	02/12/2026

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