MEDICARE: BETHESDA HERITAGE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1003847609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA HERITAGE CENTER

Provider Business Mailing Address
First Line	:	1012 3RD ST SE
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-4554
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 3RD ST SE
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-4554
Country	:	US
Telephone Number	:	320-235-3924
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANTHONY JULIAN OGDAHL
Credential	:
Telephone Number	:	320-235-3924

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/22/2020

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