Healthcare Provider Details

I. General information

NPI: 1710074554
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

800 S MAIN AVE
RUGBY ND
58368-2118
US

IV. Provider business mailing address

800 S MAIN AVE
RUGBY ND
58368-2118
US

V. Phone/Fax

Practice location:
  • Phone: 701-776-5261
  • Fax: 701-776-5448
Mailing address:
  • Phone: 701-776-5261
  • Fax: 701-776-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1048A
License Number StateND

VIII. Authorized Official

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