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NPI Code Detail

MEDICARE: BETHEL LUTHERAN NURSING & REHABILITATION CENTER

MEDICARE: BETHEL LUTHERAN NURSING & REHABILITATION 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
1314000000XSkilled Nursing Facility1058AND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2036675001OTHERNDDME-POS SUPPLIER

General Provider Information

NPI Number : 1306830427
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETHEL LUTHERAN NURSING & REHABILITATION CENTER
Provider Business Mailing Address
First Line : 1515 2ND AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-4108
Country : US
Telephone Number : 701-572-6766
Fax Number : 701-572-7579
Provider Business Practice Location Address
First Line : 1515 2ND AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-4108
Country : US
Telephone Number : 701-572-6766
Fax Number : 701-572-7579
Authorized Official
Title or Position : ADMINISTRATOR
Name : KURT STONER
Credential :
Telephone Number : 701-572-6766
Provider Enumeration Date : 09/02/2005
Last Update Date : 03/04/2015

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1922402544 — MS. SIMONE ELAINE BARDEN COTA/L
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1407379597 — MS. HANNAH ELIZABETH BAILEY M.S.
Practice Location Address:
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58801-4108
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1699245779 — LAUREN MOLIERI
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58801-4108
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