Provider Demographics
NPI:1083794432
Name:ANETA NURSING HOME INCORPORATED
Entity Type:Organization
Organization Name:ANETA NURSING HOME INCORPORATED
Other - Org Name:ANETA PARKVIEW HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-326-4234
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:113 S 5TH ST
Mailing Address - City:ANETA
Mailing Address - State:ND
Mailing Address - Zip Code:58212
Mailing Address - Country:US
Mailing Address - Phone:701-326-4234
Mailing Address - Fax:701-326-4529
Practice Address - Street 1:113 5TH ST S
Practice Address - Street 2:BOX 287
Practice Address - City:ANETA
Practice Address - State:ND
Practice Address - Zip Code:58212-4226
Practice Address - Country:US
Practice Address - Phone:701-326-4234
Practice Address - Fax:701-326-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1069B311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND030322Medicaid
ND355096Medicare ID - Type Unspecified