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General NPI Number Information
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NPI Number | 1447165972
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S NORTHERN LIGHTS VILLA LLC
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 608 MCANDERS ST SW
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City | CROSBY
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State | ND
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Zip | 58730-3322
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Country | US
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Telephone | 701-965-6384
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Fax |
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Provider Business Mailing Address
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Address Line | 702 1ST ST SW PO BOX 10
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City | CROSBY
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State | ND
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Zip | 58730-3329
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Country | US
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Telephone | 701-965-6384
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MEGAN GANSKOP
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Credential |
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Telephone | 701-965-6384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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