Provider Demographics
NPI:1578567996
Name:SISTERS OF MARY OF THE PRESENTATION LONG-TERM CARE
Entity Type:Organization
Organization Name:SISTERS OF MARY OF THE PRESENTATION LONG-TERM CARE
Other - Org Name:ROSEWOOD ON BROADWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELDINE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-277-7999
Mailing Address - Street 1:1351 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2638
Mailing Address - Country:US
Mailing Address - Phone:701-277-7999
Mailing Address - Fax:701-277-7989
Practice Address - Street 1:1351 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2638
Practice Address - Country:US
Practice Address - Phone:701-277-7999
Practice Address - Fax:701-277-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1022A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12518OtherBLUE CROSS ND
ND30420Medicaid
MN9F64R0OtherBLUE CROSS MN
MN687667600Medicaid