Basic Information
| Provider Information | |||||||||
| NPI: | 1851916449 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALTRU HEALTH SYSTEM | ||||||||
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| OtherOrganizationName: | NELSON COUNTY HEALTH SYSTEM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13780 | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582083780 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MCVILLE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582544205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013224328 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2020 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ARVIN | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7017805000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 261QR1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 261QC0050X | Y | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital |
No ID Information.