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General NPI Number Information
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NPI Number | 1538524384
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Entity Type | Organization
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Legal Business Name | BETHESDA HOSPITAL, HEALTHEAST
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 559 CAPITOL BLVD
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City | SAINT PAUL
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State | MN
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Zip | 55103-2101
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Country | US
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Telephone | 651-232-1960
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Fax |
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Provider Business Mailing Address
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Address Line | 6624 FLAG AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55428-1853
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Country | US
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Telephone | 612-384-6839
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN NUTRITIONIST
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Name | CHRISTY KAY MERTZ
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Credential |
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Telephone | 651-232-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State |
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