Healthcare Provider Details

I. General information

NPI: 1578117537
Provider Name (Legal Business Name): TRADITIONS AT WEST UNION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 HIGHWAY 150 N
WEST UNION IA
52175-1057
US

IV. Provider business mailing address

4445 2ND AVE S STE 3
FARGO ND
58103-0906
US

V. Phone/Fax

Practice location:
  • Phone: 701-936-9680
  • Fax:
Mailing address:
  • Phone: 701-936-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: AMY DEACON
Title or Position: MANAGER
Credential:
Phone: 701-936-9680