Healthcare Provider Details

I. General information

NPI: 1871586008
Provider Name (Legal Business Name): BENEDICTINE LIVING COMMUNITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 4TH AVE NE
GARRISON ND
58540
US

IV. Provider business mailing address

609 4TH AVE NE
GARRISON ND
58540
US

V. Phone/Fax

Practice location:
  • Phone: 701-463-2226
  • Fax: 701-463-2650
Mailing address:
  • Phone: 701-463-2226
  • Fax: 701-463-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1065A
License Number StateND

VIII. Authorized Official

Name: MR. SCOTT FOSS
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-463-2226