Provider Demographics
NPI:1518373224
Name:ST. ANNE'S GUEST HOME
Entity Type:Organization
Organization Name:ST. ANNE'S GUEST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-746-9401
Mailing Address - Street 1:524 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3085
Mailing Address - Country:US
Mailing Address - Phone:701-746-9401
Mailing Address - Fax:701-795-7825
Practice Address - Street 1:524 N 17TH ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3085
Practice Address - Country:US
Practice Address - Phone:701-746-9401
Practice Address - Fax:701-795-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8016311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility