NPIMap

Organization Active NPI

CHI Health Connect at Home - Fargo

Doing business as CHI Health at Home

  • Community Based Hospice Care Agency
  • Valley City, ND
National Provider Identifier
1396050860
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
6015 Issued in ND
Legal business name
CHI HEALTH CONNECT AT HOME - FARGO
Doing business as
CHI Health at Home
Practice address
367 2ND St NW
Valley City, ND 58072-2971
Phone
(701) 845-6550
Fax
(701) 845-6552
NPI assigned
Aug 9, 2010
Last updated
Jan 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMONSPIRIT HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Peyerl
Title
Director Operations/Auth Official
Phone
(701) 238-3206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 6015 ND Primary

Addresses

Primary practice location

367 2ND St NW
Valley City, ND 58072-2971

Mailing address

4265 45TH St S Ste 200
Fargo, ND 58104-4309
Phone (701) 237-8116

Other identifiers 1

IdentifierTypeStateIssuer
6015MedicaidND

Other names 1

  • CHI Health at Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110112000521 ND Part A Provider - Hospice 4789870924 Practice locations: Valley City, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396050860. Details of each certification follow.

Hospice certification: CCN 351511

Legal name
CHI HEALTH CONNECT AT HOME - FARGO
Doing business as
CHI HEALTH AT HOME
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 17, 1995
Last certification
Mar 9, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 10, 2010 in MN
Enrollment address
367 2ND St NW
Valley City, ND 58072-2971

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
CHI Health at Home - HospiceCCN 351511 · All quality measures
Ownership
For-Profit
Certified
Oct 17, 1995
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
CHI Health Connect at Home - Fargo18 organizations share this tax ID, including this one
Part of
Catholic Health Initiatives

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

367 2nd St NW
Valley City, ND 58072
Phone (701) 845-6550

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Commonspirit Health Organization, Englewood, CO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 26, 2010 100%
Wendy L McGinley Individual Corporate DirectorBoard Member Jul 1, 2019
Laura J Archuleta Individual Contracted Managing EmployeeMD; Nov 1, 2024
Nicole a Peyerl Individual Corporate OfficerMarket Vice President of Operations Oct 1, 2021
W-2 Managing EmployeeMarket Vice President of Operations Jun 1, 2022
Gretchen K Dobervich Individual Corporate DirectorBoard Member Jan 1, 2018
Mary Quandt Individual Corporate DirectorBoard Member Nov 1, 2025
Caroline Stoltz Individual Corporate DirectorBoard Member Nov 1, 2025
Lance W Gulleson Individual Corporate DirectorBoard Member Jul 1, 2018
Gloria a Dohman Individual Corporate DirectorBoard Member Jul 1, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1396050860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4265 45TH ST S STE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044309",
            "telephone_number": "701-237-8116",
            "fax_number": "701-237-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 2ND ST NW",
            "city": "VALLEY CITY",
            "state": "ND",
            "postal_code": "580722971",
            "telephone_number": "701-845-6550",
            "fax_number": "701-845-6552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHI HEALTH CONNECT AT HOME - FARGO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONSPIRIT HEALTH",
        "enumeration_date": "2010-08-09",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "PEYERL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OPERATIONS/AUTH OFFICIAL",
        "authorized_official_telephone_number": "701-238-3206"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "ND",
            "license": "6015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6015",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health at Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health at Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valley City, ND

Sources for this page

Verify at the official NPI Registry.