Provider Demographics
NPI:1578117537
Name:TRADITIONS AT WEST UNION
Entity Type:Organization
Organization Name:TRADITIONS AT WEST UNION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-936-9680
Mailing Address - Street 1:4445 2ND AVE S STE 3
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-0906
Mailing Address - Country:US
Mailing Address - Phone:701-936-9680
Mailing Address - Fax:
Practice Address - Street 1:609 HIGHWAY 150 N
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1057
Practice Address - Country:US
Practice Address - Phone:701-936-9680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care