Provider Demographics
NPI:1821077025
Name:NORTH DAKOTA VETERANS HOME
Entity Type:Organization
Organization Name:NORTH DAKOTA VETERANS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNNEBORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-683-6503
Mailing Address - Street 1:1400 ROSE ST
Mailing Address - Street 2:BOX 673
Mailing Address - City:LISBON
Mailing Address - State:ND
Mailing Address - Zip Code:58054-4846
Mailing Address - Country:US
Mailing Address - Phone:701-683-6500
Mailing Address - Fax:701-683-6550
Practice Address - Street 1:1400 ROSE ST
Practice Address - Street 2:BOX 673
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054-4846
Practice Address - Country:US
Practice Address - Phone:701-683-6500
Practice Address - Fax:701-683-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1093A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30293Medicaid
ND355114Medicare ID - Type Unspecified