1558351874 NPI number — BENEDICTINE LIVING COMMUNITIES INC.

Table of content: (NPI 1558351874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558351874 NPI number — BENEDICTINE LIVING COMMUNITIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENEDICTINE LIVING COMMUNITIES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558351874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 8TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLENDALE
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58436-7341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-349-3312
Provider Business Mailing Address Fax Number:
701-349-4550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 8TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENDALE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58436-7341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-349-3312
Provider Business Practice Location Address Fax Number:
701-349-4550
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HANSON
Authorized Official First Name:
TONY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
701-349-3312

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1064A , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30522 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000030012 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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