# MANOR ST JOSEPH

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174938773
- **Authorized official:** TAMMY JANGULA (ADMINISTRATOR)
- **Authorized official phone:** (701) 493-2477

## Contact information

- **Practice address:** 404 4TH AVE, EDGELEY, ND 58433-7417
- **Practice address phone:** (701) 493-2477
- **Mailing address:** 404 4TH AVE, EDGELEY, ND 58433-7417

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 8009 | ND | Yes |

## Other

- **Enumeration date:** 06/23/2014
- **Last updated:** 06/23/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30709 | — | ND |