Healthcare Provider Details

I. General information

NPI: 1497868061
Provider Name (Legal Business Name): ROLETTE COMMUNITY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 STATE ST.
ROLETTE ND
58366
US

IV. Provider business mailing address

804 STATE ST.
ROLETTE ND
58366
US

V. Phone/Fax

Practice location:
  • Phone: 701-246-3786
  • Fax: 701-246-3422
Mailing address:
  • Phone: 701-246-3786
  • Fax: 701-246-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHY MORROW
Title or Position: CFO
Credential:
Phone: 701-246-3786