Provider Demographics
NPI:1679563993
Name:BENEDICTINE LIVING COMMUNITIES, INC.
Entity Type:Organization
Organization Name:BENEDICTINE LIVING COMMUNITIES, INC.
Other - Org Name:ST ROSE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-883-5363
Mailing Address - Street 1:315 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:LAMOURE
Mailing Address - State:ND
Mailing Address - Zip Code:58458-7132
Mailing Address - Country:US
Mailing Address - Phone:701-883-5363
Mailing Address - Fax:701-883-5711
Practice Address - Street 1:315 1ST ST SE
Practice Address - Street 2:
Practice Address - City:LAMOURE
Practice Address - State:ND
Practice Address - Zip Code:58458-7132
Practice Address - Country:US
Practice Address - Phone:701-883-5363
Practice Address - Fax:701-883-5711
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:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1079A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000030119Medicaid
ND355107Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION #