Provider Demographics
NPI:1245441344
Name:WALHALLA COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:WALHALLA COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-549-3310
Mailing Address - Street 1:500 DELANO AVE
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282-4637
Mailing Address - Country:US
Mailing Address - Phone:701-549-3310
Mailing Address - Fax:701-549-3833
Practice Address - Street 1:500 DELANO AVE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282-4637
Practice Address - Country:US
Practice Address - Phone:701-549-3310
Practice Address - Fax:701-549-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8056A311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30736Medicaid
ND1313OtherBCBS
ND30736Medicaid