# PARKSIDE HOME

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Parkside Lutheran Home, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487658324
- **Authorized official:** MR. WAYNE HENDRICKSON (ADMINISTRATOR)
- **Authorized official phone:** (701) 683-5239

## Contact information

- **Practice address:** 501 - 3RD AVE WEST, LISBON, ND 58054-0153
- **Practice address phone:** (701) 683-5239
- **Practice address fax:** (701) 683-4109
- **Mailing address:** 501 - 3RD AVE WEST, LISBON, ND 58054-0153
- **Mailing address phone:** (701) 683-5239
- **Mailing address fax:** (701) 683-4109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1081A | ND | Yes |

## Other

- **Enumeration date:** 06/09/2005
- **Last updated:** 07/10/2007