Healthcare Provider Details

I. General information

NPI: 1447165972
Provider Name (Legal Business Name): ST. LUKE'S NORTHERN LIGHTS VILLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 MCANDERS ST SW
CROSBY ND
58730-3322
US

IV. Provider business mailing address

702 1ST ST SW PO BOX 10
CROSBY ND
58730-3329
US

V. Phone/Fax

Practice location:
  • Phone: 701-965-6384
  • Fax:
Mailing address:
  • Phone: 701-965-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MEGAN GANSKOP
Title or Position: CFO
Credential:
Phone: 701-965-6384