Healthcare Provider Details

I. General information

NPI: 1295730653
Provider Name (Legal Business Name): SISTERS OF MARY OF THE PRESENTATION LONG TERM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HILLCREST DR
ENDERLIN ND
58027-1129
US

IV. Provider business mailing address

110 HILLCREST DR
ENDERLIN ND
58027-1129
US

V. Phone/Fax

Practice location:
  • Phone: 701-437-3544
  • Fax: 701-437-3816
Mailing address:
  • Phone: 701-437-3544
  • Fax: 701-437-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1074A
License Number StateND

VII. Legacy identifiers

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

# 1
Identifier12468
Identifier TypeOTHER
Identifier StateND
Identifier IssuerND BLUE CROSS
# 2
Identifier30421
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: NANCY FARNHAM
Title or Position: CEO
Credential:
Phone: 701-437-3544