Provider Demographics
NPI:1932171642
Name:PRESENTATION CARE CENTER
Entity Type:Organization
Organization Name:PRESENTATION CARE CENTER
Other - Org Name:SMPLTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WRAALSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-3161
Mailing Address - Street 1:304 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:ROLETTE
Mailing Address - State:ND
Mailing Address - Zip Code:58366-7016
Mailing Address - Country:US
Mailing Address - Phone:701-246-3786
Mailing Address - Fax:701-246-3422
Practice Address - Street 1:304 JOHN ST
Practice Address - Street 2:
Practice Address - City:ROLETTE
Practice Address - State:ND
Practice Address - Zip Code:58366-7016
Practice Address - Country:US
Practice Address - Phone:701-246-3786
Practice Address - Fax:701-246-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1061A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND355081Medicare Oscar/Certification