Provider Demographics
NPI:1063401867
Name:NORTHWOOD DEACONESS HEALTH CENTER
Entity type:Organization
Organization Name:NORTHWOOD DEACONESS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANTONSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:701-587-6459
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:4 N. PARK ST.
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0190
Mailing Address - Country:US
Mailing Address - Phone:701-587-6459
Mailing Address - Fax:701-587-6479
Practice Address - Street 1:4 N PARK ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-4102
Practice Address - Country:US
Practice Address - Phone:701-587-6459
Practice Address - Fax:701-587-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1045A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30031Medicaid
ND30031Medicaid