Provider Demographics
NPI:1396088373
Name:ST. LUKE'S HOSPITAL
Entity type:Organization
Organization Name:ST. LUKE'S HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:URVAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-965-6384
Mailing Address - Street 1:705 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-3325
Mailing Address - Country:US
Mailing Address - Phone:701-965-6086
Mailing Address - Fax:701-965-6381
Practice Address - Street 1:705 4TH ST SE
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-3325
Practice Address - Country:US
Practice Address - Phone:701-965-6086
Practice Address - Fax:701-965-6381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-28
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30521Medicaid
ND30521Medicaid