1023493293 NPI number — SISTERS OF MARY OF THE PRESENTATION LONG-TERM CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023493293 NPI number — SISTERS OF MARY OF THE PRESENTATION LONG-TERM CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SISTERS OF MARY OF THE PRESENTATION LONG-TERM CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SMP HEALTH - ST RAPHAEL - GERI PSYCH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023493293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
979 CENTRAL AVE NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY CITY
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-845-8222
Provider Business Mailing Address Fax Number:
701-845-8249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
979 CENTRAL AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY CITY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58072-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-845-8222
Provider Business Practice Location Address Fax Number:
701-845-8249
Provider Enumeration Date:
07/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
AUS
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
701-845-8202

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1053B , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30423 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1455437 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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