Provider Demographics
NPI:1912466947
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
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:KREIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSN, RN
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:58601-3997
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:58601-3997
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:2019-03-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility