Healthcare Provider Details

I. General information

NPI: 1912466947
Provider Name (Legal Business Name): ST. LUKE'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
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
58601-3997
US

IV. Provider business mailing address

242 10TH ST W
DICKINSON ND
58601-3997
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 Number
License Number State

VIII. Authorized Official

Name: AMY LEANNE KREIDT
Title or Position: CEO
Credential: MBA, MSN, RN
Phone: 701-483-5000