Healthcare Provider Details

I. General information

NPI: 1396088373
Provider Name (Legal Business Name): ST. LUKE'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 4TH ST SE
CROSBY ND
58730-3325
US

IV. Provider business mailing address

705 4TH ST SE
CROSBY ND
58730-3325
US

V. Phone/Fax

Practice location:
  • Phone: 701-965-6086
  • Fax: 701-965-6381
Mailing address:
  • Phone: 701-965-6086
  • Fax: 701-965-6381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LESLIE A URVAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-965-6384