NPIMap

Organization Active NPI

McKenzie County Healthcare Systems Inc

Doing business as Good Shepherd Home

  • Custodial Care Facility
  • Watford City, ND
National Provider Identifier
1689698193
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Custodial Care FacilityTaxonomy code 311Z00000X
Legal business name
MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Doing business as
Good Shepherd Home
Practice address
709 4TH Ave NE
Watford City, ND 58854-7628
Phone
(701) 444-2331
Fax
(701) 444-4629
NPI assigned
Jul 27, 2006
Last updated
Dec 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MCKENZIE COUNTY HEALTHCARE SYSTEMS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Authorized official

Name
Daniel R. Kelly
Title
Chief Executive Officer
Phone
(701) 842-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Custodial Care Facility 311Z00000X Primary

Addresses

Primary practice location

709 4TH Ave NE
Watford City, ND 58854-7628

Mailing address

709 4TH Ave NE
Watford City, ND 58854-7628
Phone (701) 444-2331

Other names 1

  • Good Shepherd Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
McKenzie County Healthcare12 organizations share this tax ID, including this one
Part of
McKenzie County Healthcare

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1689698193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 4TH AVE NE",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547628",
            "telephone_number": "701-444-2331",
            "fax_number": "701-444-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 4TH AVE NE",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547628",
            "telephone_number": "701-444-2331",
            "fax_number": "701-444-4629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKENZIE COUNTY HEALTHCARE SYSTEMS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCKENZIE COUNTY HEALTHCARE SYSTEMS INC",
        "enumeration_date": "2006-07-27",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "701-842-3000"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watford City, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.