# PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wedgewood Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356487565
- **Authorized official:** LISA LETEXIER (CEO)
- **Authorized official phone:** (701) 265-6228

## Contact information

- **Practice address:** 804 MAIN ST W, CAVALIER, ND 58220-4646
- **Practice address phone:** (701) 265-8453
- **Mailing address:** PO BOX 380, CAVALIER, ND 58220-0380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1011B | ND | Yes |

## Other

- **Enumeration date:** 01/29/2007
- **Last updated:** 07/25/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | MEDICAID ID | — | ND |