Provider Demographics
NPI:1548426430
Name:SHIPLEY BASIC CARE
Entity Type:Organization
Organization Name:SHIPLEY BASIC CARE
Other - Org Name:ROSEADELE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-251-1741
Mailing Address - Street 1:1505 3 ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401
Mailing Address - Country:US
Mailing Address - Phone:701-251-1741
Mailing Address - Fax:701-252-1207
Practice Address - Street 1:1505 3 ST SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-251-1741
Practice Address - Fax:701-252-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8038B311500000X
311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)