=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205041985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENEDICTINE LIVING CENTER OF GARRISON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 05/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 FOURTH AVE NE
-----------------------------------------------------
City | GARRISON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58540-0219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-463-2226
-----------------------------------------------------
Fax | 701-463-2910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 609 FOURTH AVE NE
-----------------------------------------------------
City | GARRISON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-463-2226
-----------------------------------------------------
Fax | 701-463-2910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SCOTT FOSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 701-463-2226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 845
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------