Healthcare Provider Details

I. General information

NPI: 1306964838
Provider Name (Legal Business Name): BETHESDA OF BERESFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W CEDAR ST
BERESFORD SD
57004-1125
US

IV. Provider business mailing address

606 W CEDAR ST
BERESFORD SD
57004-1125
US

V. Phone/Fax

Practice location:
  • Phone: 605-763-2050
  • Fax: 605-763-2063
Mailing address:
  • Phone: 605-763-2050
  • Fax: 605-763-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10595
License Number StateSD

VIII. Authorized Official

Name: TANYA K LAMBERT
Title or Position: BILLING SPECIALIST
Credential:
Phone: 605-763-2050