Provider Demographics
NPI:1588763247
Name:WEST RIVER HEALTH SERVICES
Entity type:Organization
Organization Name:WEST RIVER HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STADHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-567-6150
Mailing Address - Street 1:1000 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-7530
Mailing Address - Country:US
Mailing Address - Phone:701-567-4561
Mailing Address - Fax:701-567-6361
Practice Address - Street 1:1000 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639-7530
Practice Address - Country:US
Practice Address - Phone:701-567-4561
Practice Address - Fax:701-567-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5025282NC0060X
ND1813336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1028Medicaid
SD5520180Medicaid
ND00257OtherBLUE CROSS
SD0120180Medicaid
SD5520180Medicaid
WA3018140Medicaid
IA0951947Medicaid
ND00257OtherBLUE CROSS
SD5520180Medicaid
MN537847800Medicaid