Provider Demographics
NPI:1023062155
Name:ST. LUKE'S HOME
Entity type:Organization
Organization Name:ST. LUKE'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:KREIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-483-5000
Mailing Address - Street 1:242 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3926
Mailing Address - Country:US
Mailing Address - Phone:701-483-5000
Mailing Address - Fax:701-483-5007
Practice Address - Street 1:242 10TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601
Practice Address - Country:US
Practice Address - Phone:701-483-5000
Practice Address - Fax:701-483-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1015A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1370OtherBCBS OF ND
ND30011Medicaid
ND30011Medicaid
ND1370OtherBCBS OF ND
ND355063Medicare PIN