Healthcare Provider Details

I. General information

NPI: 1932171642
Provider Name (Legal Business Name): PRESENTATION CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 JOHN ST
ROLETTE ND
58366-7016
US

IV. Provider business mailing address

304 JOHN ST
ROLETTE ND
58366-7016
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 TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1061A
License Number StateND

VIII. Authorized Official

Name: MS. KIMBER L WRAALSTAD
Title or Position: CEO
Credential:
Phone: 701-477-3161