Provider Demographics
NPI:1558351874
Name:BENEDICTINE LIVING COMMUNITIES INC.
Entity Type:Organization
Organization Name:BENEDICTINE LIVING COMMUNITIES INC.
Other - Org Name:PRINCE OF PEACE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-349-3312
Mailing Address - Street 1:201 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:ND
Mailing Address - Zip Code:58436-7341
Mailing Address - Country:US
Mailing Address - Phone:701-349-3312
Mailing Address - Fax:701-349-4550
Practice Address - Street 1:201 8TH ST N
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:ND
Practice Address - Zip Code:58436-7341
Practice Address - Country:US
Practice Address - Phone:701-349-3312
Practice Address - Fax:701-349-4550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEDICTINE LIVING COMMUNITIES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-27
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1064A314000000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30522Medicaid
ND000030012Medicaid
ND30522Medicaid