Provider Demographics
NPI:1922195767
Name:GOOD SAMARITAN HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL ASSOCIATION
Other - Org Name:HAROLD S. HAALAND HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-776-5261
Mailing Address - Street 1:1025 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-2523
Mailing Address - Country:US
Mailing Address - Phone:701-776-5203
Mailing Address - Fax:701-776-6688
Practice Address - Street 1:1025 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-2523
Practice Address - Country:US
Practice Address - Phone:701-776-5203
Practice Address - Fax:701-776-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8031A311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30707Medicaid