Provider Demographics
NPI:1144636051
Name:SHERIDAN MEMORIAL HOME
Entity type:Organization
Organization Name:SHERIDAN MEMORIAL HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-363-2203
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:610 SOUTH MAIN
Mailing Address - City:MCCLUSKY
Mailing Address - State:ND
Mailing Address - Zip Code:58463-0350
Mailing Address - Country:US
Mailing Address - Phone:701-363-2203
Mailing Address - Fax:701-363-2718
Practice Address - Street 1:610 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:MCCLUSKY
Practice Address - State:ND
Practice Address - Zip Code:58463-0350
Practice Address - Country:US
Practice Address - Phone:701-363-2203
Practice Address - Fax:701-363-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care