Healthcare Provider Details

I. General information

NPI: 1811039316
Provider Name (Legal Business Name): DUNSEITH COMMUNITY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FIRST ST NE
DUNSEITH ND
58329
US

IV. Provider business mailing address

BOX 669 15 FIRST ST NE
DUNSEITH ND
58329
US

V. Phone/Fax

Practice location:
  • Phone: 701-244-5495
  • Fax: 701-244-5431
Mailing address:
  • Phone: 701-244-5495
  • Fax: 701-244-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1016A
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30052
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: MR. JUSTIN LEE DECOTEAU
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-244-5495