MEDICARE: BD BEND III LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558580993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BD BEND III LLC

Provider Business Mailing Address
First Line	:	119 SE WILSON AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-1714
Country	:	US
Telephone Number	:	541-382-7161
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 SE WILSON AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-1714
Country	:	US
Telephone Number	:	541-382-7161
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. DOUG DEVORE
Credential	:
Telephone Number	:	425-392-4066

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	05/25/2010

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Directions to “BD BEND III LLC ” Practice Location

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