The Odd Fellows and Rebekah Home of North Dakota Inc.

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

License

8007 Issued in ND

Legal business name

THE ODD FELLOWS AND REBEKAH HOME OF NORTH DAKOTA INC.

Doing business as

Odd Fellows Home

Practice address

1107 Walnut St E
Devils Lake, ND 58301-3240

Phone

(701) 662-3330

NPI assigned

Jun 23, 2014

Last updated

Jun 23, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Ulrich

Title

Administrator

Phone

(701) 662-3330

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Odd Fellows Home Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1588079156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 WALNUT ST E",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583013240",
            "telephone_number": "701-662-3330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 WALNUT ST E",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583013240",
            "telephone_number": "701-662-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ODD FELLOWS AND REBEKAH HOME OF NORTH DAKOTA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "ULRICH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "701-662-3330"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "ND",
            "license": "8007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30713",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odd Fellows Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Custodial Care Facility in Devils Lake, ND
• Providers in Devils Lake, ND by specialty
• Custodial Care Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.