Healthcare Provider Details

I. General information

NPI: 1427050525
Provider Name (Legal Business Name): BETHESDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 3RD ST SE
WILLMAR MN
56201-4554
US

IV. Provider business mailing address

1012 3RD ST SE
WILLMAR MN
56201-4554
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-3924
  • Fax: 320-231-3399
Mailing address:
  • Phone: 320-235-3924
  • Fax: 320-231-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number327806
License Number StateMN

VIII. Authorized Official

Name: MRS. ALANA SUE ZIEHL
Title or Position: OFFICE MANAGER
Credential:
Phone: 320-235-9532