CHI Health Connect at Home-Fargo
Organization Active NPI Community Based Hospice Care Agency · Dickinson, ND
NPI 1578878047 · NPPES record last updated Jan 22, 2024
Key facts
- NPI
- 1578878047
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 6005 (ND)
- Legal business name
- CHI HEALTH CONNECT AT HOME-FARGO
- Practice address
- 986 2ND Avenue West
Dickinson, ND 58601-3916 - Phone
- (701) 456-4378
- Fax
- (701) 456-4809
- NPI assigned
- Aug 9, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMONSPIRIT HEALTH
Authorized official
- Name
- Nicole Peyerl
- Title
- Director Operations/Auth Official
- Phone
- (701) 238-3206
Owners & managing parties with NPI records 1
-
Laura Archuleta, M.D.
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 17
Practitioners 2
-
Stacie Cleveland, FNP-C
-
Michelle A Cooley, NP-C
Affiliated clinicians 7
-
Laura Archuleta, M.D.
-
Mathew Gerving, MD
-
Lee Kiedrowski, MD
-
Bruce W Olin, MD
-
Cory E. Rathgeber, M.D.
-
Nolan M Kleinjan, MD
Medicare Care Compare: Hospice
- Listed as
- CHI Health at Home - Hospice
- Ownership
- Other
- Certified
- Dec 4, 1991
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Hospice certification: CCN 351507
- Legal name
- CHI HEALTH CONNECT AT HOME - FARGO
- Doing business as
- CHI HEALTH AT HOME
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Dec 4, 1991
- Last certification
- Jun 8, 2022
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 10, 2010 in MN
- Enrollment address
- 986 2ND Ave W
Dickinson, ND 58601-3916
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Glenda S Reemts |
Corporate Director |
Oct 1, 2018 | |
| Commonspirit Health |
5% Or Greater Direct Ownership Interest | Dec 26, 2010 | 100% |
| Wendy L McGinley |
Corporate Director |
Jul 1, 2019 | |
| Laura J Archuleta |
Contracted Managing Employee |
Sep 1, 2020 | |
| Mary P Burger |
Corporate Director |
Jul 1, 2014 | |
| Nicole a Peyerl |
Corporate Officer |
Oct 1, 2021 | |
| W-2 Managing Employee |
Oct 1, 2021 | ||
| Douglas a Harildstad |
Corporate Director |
Jul 1, 2011 | |
| Kevin E Lofton |
Operational/Managerial Control |
Dec 26, 2010 | |
| Gretchen K Dobervich |
Corporate Director |
Jan 1, 2018 | |
| Chad D Peterson |
Corporate Director |
Jul 1, 2014 | |
| Lance W Gulleson |
Corporate Director |
Jul 1, 2018 | |
| Karen B Fixen-Bercier |
W-2 Managing Employee |
Jul 13, 2023 | |
| Gloria a Dohman |
Corporate Director |
Jul 1, 2017 | |
| Jeffrey Drop |
Corporate Director |
Dec 26, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101201000195 | ND | Part a Provider - Hospice | 4789870924 | Practice locations: Dickinson, ND |
National Provider Directory
- Tax ID family
- CHI Health Connect at Home
- Part of
- Catholic Health Initiatives
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 6005 | ND | Yes |
Addresses
Primary practice location
986 2ND Avenue West
Dickinson, ND 58601-3916
Mailing address
4265 45TH St S Ste 200
Fargo, ND 58104-4309
Phone (701) 237-8116
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55830 | Medicaid | ND | |
| 6005 | Medicaid | ND |
Other names
- CHI Health at Home
Other providers in Dickinson, ND
- Libby Chau
- Kristi Jean Chavez
- Janel Kay Chays
- Kelly M Chevalier
- CHI Health Connect at Home-Fargo
- CHI St. Joseph'S Hospital
- Kuziwa Enedia Chitiyo
- Tamara J. Christianson
- City of Dickinson
- Teri Marie Clark
All providers in Dickinson, ND · Community Based Hospice Care Agency in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.