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General NPI Number Information
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NPI Number | 1033113626
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Entity Type | Organization
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Legal Business Name | BETHESDA
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 901 WILLMAR AVE SE
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City | WILLMAR
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State | MN
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Zip | 56201-4604
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Country | US
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Telephone | 320-235-9532
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Fax | 320-235-7909
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Provider Business Mailing Address
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Address Line | 1604 1ST ST S
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City | WILLMAR
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State | MN
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Zip | 56201-4243
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Country | US
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Telephone | 320-235-8364
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ALANA ZIEHL
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Credential |
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Telephone | 320-214-5603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 02926
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License Number State | MN
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