Provider Demographics
NPI:1780672253
Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Entity Type:Organization
Organization Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Other - Org Name:BAPTIST HOME OF KENMARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-253-1485
Mailing Address - Street 1:315 2ND AVE NW
Mailing Address - Street 2:PO BOX 787
Mailing Address - City:KENMARE
Mailing Address - State:ND
Mailing Address - Zip Code:58746-7160
Mailing Address - Country:US
Mailing Address - Phone:701-385-4941
Mailing Address - Fax:701-385-4215
Practice Address - Street 1:315 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746-7160
Practice Address - Country:US
Practice Address - Phone:701-385-4941
Practice Address - Fax:701-385-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8022A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30700Medicaid