Healthcare Provider Details

I. General information

NPI: 1578554374
Provider Name (Legal Business Name): BENEDICTINE LIVING COMMUNITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 4TH AVE E
DICKINSON ND
58601-4014
US

IV. Provider business mailing address

1839 E CAPITOL AVE
BISMARCK ND
58501-5616
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-7242
  • Fax: 701-456-7250
Mailing address:
  • Phone: 701-250-1006
  • Fax: 701-250-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1063A
License Number StateND

VIII. Authorized Official

Name: MR. RONALD FREI
Title or Position: REGIONAL DIRECTOR OF FINANCE
Credential:
Phone: 701-250-1006