# 4000 VALLEY SQUARE INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VALLEY MEMORIAL HOMES
- **Other names:** WOODSIDE VILLAGE, Valley Senior Living on 42nd, Country Estates, Wheatland Terrace
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275627184
- **Legal business name:** VALLEY MEMORIAL HOMES
- **Authorized official:** MRS. MEGAN ANDERSON (ADMINISTRATIVE PROJECT COORDINATOR)
- **Authorized official phone:** (701) 787-7970

## Contact information

- **Practice address:** 4000 24TH AVE S, GRAND FORKS, ND 58201-8863
- **Practice address phone:** (701) 787-7500
- **Practice address fax:** (701) 787-7822
- **Mailing address:** 4000 24TH AVE S, GRAND FORKS, ND 58201-8863
- **Mailing address phone:** (701) 787-7500
- **Mailing address fax:** (701) 787-7822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1077A | ND | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 08/22/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 03-0201 | — | ND |