# DICKINSON COUNTRYHOUSE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dickinson CountryHouse LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548050461
- **Authorized official:** STACY RANDELS (VP ASSET MANAGEMENT)
- **Authorized official phone:** (531) 800-3364

## Contact information

- **Practice address:** 628 24TH ST W, DICKINSON, ND 58601-2731
- **Practice address phone:** (701) 847-0842
- **Mailing address:** 17110 MARCY ST STE LL01, OMAHA, NE 68118-3119
- **Mailing address phone:** (531) 800-3364
- **Mailing address fax:** (531) 800-3364

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 311500000X | Alzheimer Center (Dementia Center) | — | NULL | Yes |

## Other

- **Enumeration date:** 05/12/2025
- **Last updated:** 05/23/2025