Healthcare Provider Details

I. General information

NPI: 1790740066
Provider Name (Legal Business Name): BETHESDA ADULT DAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WILLMAR AVE SE
WILLMAR MN
56201-4604
US

IV. Provider business mailing address

901 WILLMAR AVE SE
WILLMAR MN
56201-4604
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-9532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: MS. ALANA ZIEHL
Title or Position: OFFICE MANAGER
Credential:
Phone: 320-214-5603