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General NPI Number Information
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NPI Number | 1770552820
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Entity Type | Organization
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Legal Business Name | BENEDICTINE LIVING COMMUNITIES, INC.
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 1307 7TH ST N
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City | WAHPETON
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State | ND
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Zip | 58075-3624
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Country | US
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Telephone | 701-642-6667
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Fax | 701-642-2485
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Provider Business Mailing Address
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Address Line | 1307 7TH ST N
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City | WAHPETON
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State | ND
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Zip | 58075-3624
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Country | US
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Telephone | 701-642-6667
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Fax | 701-642-2485
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JIM CORNELIUS
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Credential |
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Telephone | 701-642-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 4065A
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License Number State | ND
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