Healthcare Provider Details

I. General information

NPI: 1457224370
Provider Name (Legal Business Name): MARIAN MANOR COMMUNITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E ASH AVE
GLEN ULLIN ND
58631-7138
US

IV. Provider business mailing address

604 E ASH AVE
GLEN ULLIN ND
58631-7138
US

V. Phone/Fax

Practice location:
  • Phone: 701-348-3107
  • Fax: 701-348-3080
Mailing address:
  • Phone: 701-348-3107
  • Fax: 701-348-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ANDREW STEVEN COTANT
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-348-3107