Provider Demographics
NPI:1457224370
Name:MARIAN MANOR COMMUNITY CORPORATION
Entity type:Organization
Organization Name:MARIAN MANOR COMMUNITY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:COTANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-348-3107
Mailing Address - Street 1:604 E ASH AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ULLIN
Mailing Address - State:ND
Mailing Address - Zip Code:58631-7138
Mailing Address - Country:US
Mailing Address - Phone:701-348-3107
Mailing Address - Fax:701-348-3080
Practice Address - Street 1:604 E ASH AVE
Practice Address - Street 2:
Practice Address - City:GLEN ULLIN
Practice Address - State:ND
Practice Address - Zip Code:58631-7138
Practice Address - Country:US
Practice Address - Phone:701-348-3107
Practice Address - Fax:701-348-3080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIAN MANOR COMMUNITY CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility