Basic Information
| Provider Information | |||||||||
| NPI: | 1639765118 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NELSON COUNTY HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 367 | ||||||||
| Address2: | |||||||||
| City: | MCVILLE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582540367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013224328 | ||||||||
| FaxNumber: | 7013222250 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 E NYHUS AVE | ||||||||
| Address2: | |||||||||
| City: | MCVILLE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582544110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013224314 | ||||||||
| FaxNumber: | 7013225533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2020 | ||||||||
| LastUpdateDate: | 12/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | FORDE | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7013224328 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NELSON COUNTY HEALTH SYSTEM | ||||||||
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| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 1456521 | 05 | ND | MEDICAID |