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DICKINSON COUNTRYHOUSE LLC
NPI 1548050461
Alzheimer Center (Dementia Center) in Dickinson, ND

Active since May 12, 2025CLIA 35D1040908 · Waiver
628 24TH ST W, DICKINSON, ND 58601(701) 847-0842 Get Directions Write a Review

NPPES record last updated: May 23, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 23, 2025, May 12, 2025 (2 updates tracked since 2025).

About Dickinson Countryhouse Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DICKINSON COUNTRYHOUSE LLC (NPI 1548050461) is a healthcare organization registered as an alzheimer center (dementia center) in Dickinson, North Dakota and active in the NPI registry since May 2025. The organization holds a CLIA Waiver certificate valid through May 18, 2027 and lists Stacy Randels, Vp Asset Management, as its authorized official.

NPPES Registry Identity

NPI1548050461
Entity TypeOrganization
Primary Taxonomy311500000X
Legal Business NameDICKINSON COUNTRYHOUSE LLC
Location Address628 24TH ST WDickinson, ND 58601-2731
Mailing Address17110 Marcy St Ste Ll01Omaha, NE 68118-3119 · (531) 800-3364 · Fax (531) 800-3364
Phone(701) 847-0842
Organization SubpartNo
Authorized OfficialStacy RandelsVp Asset Management · (531) 800-3364
Enumeration DateMay 12, 2025
Last NPPES UpdateMay 23, 20252 updates tracked since enumeration
NPPES CertifiedMay 23, 2025
✔ NPI 1548050461 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAlzheimer Center (Dementia Center)Nursing & Custodial Care Facilities
Taxonomy Code311500000X
Definition
A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer's Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations.
Also ListedIn Home Supportive CareTaxonomy 253Z00000X
628 24TH ST W, Dickinson, ND 58601
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Other Names 1

Doing Business AsDickinson Countryhouse Llc

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 35D1040908

Dickinson Country House LLC · Dickinson, ND
Active · expires May 18, 2027
CLIA Number35D1040908
Laboratory TypeBasic Care Facility
Certificate Effective DateMay 19, 2025
Certificate Expiration DateMay 18, 2027
Laboratory DirectorStephanie M. Hauge
Laboratory Phone(701) 483-2266
Laboratory LocationDickinson Country House LLC628 24th St W, Dickinson, ND 58601
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EMPOWERME ASL, LLC
Clinic/Center (Multi-Specialty)
628 24TH ST W
DICKINSON, ND 58601
Stark County (844) 502-7996

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dickinson Countryhouse LLC's NPI number?

The NPI number for Dickinson Countryhouse LLC is 1548050461. It was assigned to this organization in the NPPES registry on May 12, 2025.

Where is Dickinson Countryhouse LLC located?

Dickinson Countryhouse LLC is located at 628 24th St W, Dickinson, ND 58601. The listed phone number is (701) 847-0842.

What is Dickinson Countryhouse LLC's specialty?

The primary specialty registered for this NPI is Alzheimer Center (Dementia Center) with taxonomy code 311500000X.

Does Dickinson Countryhouse LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 35D1040908) is associated with this NPI, valid through May 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Dickinson Countryhouse LLC was last updated on May 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.