Provider Demographics
NPI:1811039316
Name:DUNSEITH COMMUNITY NURSING HOME
Entity Type:Organization
Organization Name:DUNSEITH COMMUNITY NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRILL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRENNO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMINIS
Authorized Official - Phone:701-244-5495
Mailing Address - Street 1:BOX 669 15 FIRST ST NE
Mailing Address - Street 2:
Mailing Address - City:DUNSEITH
Mailing Address - State:ND
Mailing Address - Zip Code:58329
Mailing Address - Country:US
Mailing Address - Phone:701-244-5495
Mailing Address - Fax:701-244-5431
Practice Address - Street 1:15 FIRST ST NE
Practice Address - Street 2:
Practice Address - City:DUNSEITH
Practice Address - State:ND
Practice Address - Zip Code:58329
Practice Address - Country:US
Practice Address - Phone:701-244-5495
Practice Address - Fax:701-244-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1016A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30052Medicaid
355080Medicare ID - Type Unspecified