Dickinson Countryhouse LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

DICKINSON COUNTRYHOUSE LLC

Practice address

628 24TH St W
Dickinson, ND 58601-2731

Phone

(701) 847-0842

NPI assigned

May 12, 2025

Organization subpart

No

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

Authorized official

Name

Stacy Randels

Title

VP Asset Management

Phone

(531) 800-3364

Specialties & licenses 2

Addresses

Other names 1

• Dickinson CountryHouse LLC Doing business as

Locations

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

{
    "created_epoch": "1747008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747958400000",
    "number": "1548050461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17110 MARCY ST STE LL01",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681183119",
            "telephone_number": "531-800-3364",
            "fax_number": "531-800-3364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 24TH ST W",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586012731",
            "telephone_number": "701-847-0842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKINSON COUNTRYHOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-12",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A",
        "authorized_official_last_name": "RANDELS",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "VP ASSET MANAGEMENT",
        "authorized_official_telephone_number": "531-800-3364"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dickinson CountryHouse LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dickinson CountryHouse LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard N Demolen, PSYD
• Jill Desalvio, P.T.
• Jill Deschamp, COTA-L
• Courtney Deyoung
• Dickinson Area Ambulance Service Inc
• Dickinson Dental Center, P.C.
• Dickinson Family Counseling Center
• Dickinson Public Schools
• Terris Dietz
• Chelsea McCall Dinius, APRN, CPNP-PC

• Alzheimer Center (Dementia Center) in Dickinson, ND
• Providers in Dickinson, ND by specialty
• Alzheimer Center (Dementia Center) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.