Provider Demographics
NPI:1861458622
Name:ST GERARDS COMMUNITY OF CARE
Entity Type:Organization
Organization Name:ST GERARDS COMMUNITY OF CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MED. RECORDS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THEEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-242-7891
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:613 1ST AVE. SW
Mailing Address - City:HANKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58041-0448
Mailing Address - Country:US
Mailing Address - Phone:701-242-7891
Mailing Address - Fax:701-242-7895
Practice Address - Street 1:613 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:HANKINSON
Practice Address - State:ND
Practice Address - Zip Code:58041-0448
Practice Address - Country:US
Practice Address - Phone:701-242-7891
Practice Address - Fax:701-242-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1028A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30163Medicaid
ND30163Medicaid