Healthcare Provider Details

I. General information

NPI: 1922195767
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 3RD AVE SE
RUGBY ND
58368-2523
US

IV. Provider business mailing address

1025 3RD AVE SE
RUGBY ND
58368-2523
US

V. Phone/Fax

Practice location:
  • Phone: 701-776-5203
  • Fax: 701-776-6688
Mailing address:
  • Phone: 701-776-5203
  • Fax: 701-776-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number8031A
License Number StateND

VIII. Authorized Official

Name: ERIK T CHRISTENSON
Title or Position: CEO
Credential:
Phone: 701-776-5261