Provider Demographics
NPI:1497868061
Name:ROLETTE COMMUNITY CARE CENTER, INC.
Entity Type:Organization
Organization Name:ROLETTE COMMUNITY CARE CENTER, INC.
Other - Org Name:ROLETTE COMMUNITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-246-3786
Mailing Address - Street 1:804 STATE ST.
Mailing Address - Street 2:
Mailing Address - City:ROLETTE
Mailing Address - State:ND
Mailing Address - Zip Code:58366
Mailing Address - Country:US
Mailing Address - Phone:701-246-3786
Mailing Address - Fax:701-246-3422
Practice Address - Street 1:804 STATE ST.
Practice Address - Street 2:
Practice Address - City:ROLETTE
Practice Address - State:ND
Practice Address - Zip Code:58366
Practice Address - Country:US
Practice Address - Phone:701-246-3786
Practice Address - Fax:701-246-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30466Medicaid
ND30466Medicaid