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Organization Active NPI

Altru Health System

  • Home Infusion Therapy Pharmacy
  • Grand Forks, ND
National Provider Identifier
1497844906
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
License
180 Issued in ND
Legal business name
ALTRU HEALTH SYSTEM
Practice address
1200 S Columbia Rd
Grand Forks, ND 58201-4036
Phone
(701) 780-5888
Fax
(701) 780-5849
NPI assigned
Oct 12, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Derek Goebel
Title
Chief Financial Officer
Phone
(701) 780-1470

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 675

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 675

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240306001883 ND DME Supplier - PharmacyDME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Registered PharmacistDME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Oxygen & Equipment 1355251604 Practice locations: Grand Forks, ND

All facility ownership & control disclosures 4

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Altru Rehabilitation HospitalGrand Forks, ND, CCN 353027 Hospital 5% Or Greater Direct Ownership Interest (40%) May 24, 2021
Valley Senior Living on ColumbiaGrand Forks, ND, CCN 355067 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 1994
May 21, 2025
Woodside VillageGrand Forks, ND, CCN 355112 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 1994
May 21, 2025
Altru'S Home HealthGrand Forks, ND, CCN 357014 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1997

National Provider Directory

National Provider Directory
Tax ID family
Altru Lakewood Physicia24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Locations

4350 S Washington St
Ste 100
Grand Forks, ND 58201
Phone (701) 732-2888

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Home Infusion Therapy Pharmacy 3336H0001X 180 ND Primary
Home Infusion Therapy Pharmacy 3336H0001X 261742 MN

Addresses

NPPES NPI Registry

Primary practice location

1200 S Columbia Rd
Grand Forks, ND 58201-4036

Mailing address

1200 S Columbia Rd
Grand Forks, ND 58201-4036

Other names 1

NPPES NPI Registry
  • ALTRU SPECIALTY SERVICES, INC. Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 20, 2024.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734652800000",
    "number": "1497844906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014036",
            "telephone_number": "701-780-5888",
            "fax_number": "701-780-5849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTRU HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A",
        "authorized_official_last_name": "GOEBEL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "701-780-1470"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "ND",
            "license": "180",
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "MN",
            "license": "261742",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALTRU SPECIALTY SERVICES, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.