Provider Demographics
NPI:1588763932
Name:TRAILL DISTRICT HEALTH UNIT
Entity type:Organization
Organization Name:TRAILL DISTRICT HEALTH UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN DIRECTOR
Authorized Official - Phone:701-636-4434
Mailing Address - Street 1:114 W CALEDONIA AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045
Mailing Address - Country:US
Mailing Address - Phone:701-636-4434
Mailing Address - Fax:701-636-5473
Practice Address - Street 1:114 WEST CALEDONIA AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045
Practice Address - Country:US
Practice Address - Phone:701-636-4434
Practice Address - Fax:701-636-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND40251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN057983Medicaid
NDN70546Medicare PIN