Provider Demographics
NPI:1427371889
Name:BENEDICTINE LIVING COMMUNITIES-BISMARCK, INC.
Entity Type:Organization
Organization Name:BENEDICTINE LIVING COMMUNITIES-BISMARCK, INC.
Other - Org Name:ST. GABRIEL'S COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRZYBILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-751-4224
Mailing Address - Street 1:4580 COLEMAN STREET
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0347
Mailing Address - Country:US
Mailing Address - Phone:701-751-4224
Mailing Address - Fax:
Practice Address - Street 1:4580 COLEMAN STREET
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0347
Practice Address - Country:US
Practice Address - Phone:701-751-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEDICTINE LIVING COMMUNITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-12
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND355126Medicare Oscar/Certification
ND355126Medicare PIN