Basic Information
| Provider Information | |||||||||
| NPI: | 1356462709 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRINITY KENMARE HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | TRINITY KENMARE NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 697 | ||||||||
| Address2: | |||||||||
| City: | KENMARE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587460697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018575178 | ||||||||
| FaxNumber: | 7018575117 | ||||||||
| Practice Location | |||||||||
| Address1: | 317 1ST AVE NW | ||||||||
| Address2: | |||||||||
| City: | KENMARE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018575178 | ||||||||
| FaxNumber: | 7018575117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SEEHAFER | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | NOLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7018575178 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1035C | ND | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.