Healthcare Provider Details

I. General information

NPI: 1083620199
Provider Name (Legal Business Name): ST. LUKE'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 1ST SW
CROSBY ND
58730-0010
US

IV. Provider business mailing address

PO BOX 10
CROSBY ND
58730-0010
US

V. Phone/Fax

Practice location:
  • Phone: 701-965-6384
  • Fax: 701-965-4258
Mailing address:
  • Phone: 701-965-6384
  • Fax: 701-965-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5011A
License Number StateND

VIII. Authorized Official

Name: MR. LESLIE O URVAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-965-6384