Healthcare Provider Details

I. General information

NPI: 1023062155
Provider Name (Legal Business Name): ST. LUKE'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 10TH ST W
DICKINSON ND
58601
US

IV. Provider business mailing address

242 10TH ST W
DICKINSON ND
58601-3926
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-5000
  • Fax: 701-483-5007
Mailing address:
  • Phone: 701-483-5000
  • Fax: 701-483-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1015A
License Number StateND

VIII. Authorized Official

Name: AMY LEANNE KREIDT
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 701-483-5000