Provider Demographics
NPI:1578554374
Name:BENEDICTINE LIVING COMMUNITIES, INC.
Entity Type:Organization
Organization Name:BENEDICTINE LIVING COMMUNITIES, INC.
Other - Org Name:ST. BENEDICT'S HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-250-1006
Mailing Address - Street 1:1839 E CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-5616
Mailing Address - Country:US
Mailing Address - Phone:701-250-1006
Mailing Address - Fax:701-250-1060
Practice Address - Street 1:851 4TH AVE E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4014
Practice Address - Country:US
Practice Address - Phone:701-456-7242
Practice Address - Fax:701-456-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1063A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00030237Medicaid
ND355090Medicare ID - Type Unspecified