MEDICARE: BETHANY LUTHERAN HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	10677	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	85096	OTHER		BC & BS

General Provider Information

NPI Number	:	1023063856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY LUTHERAN HOME

Provider Business Mailing Address
First Line	:	1901 S HOLLY AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-2407
Country	:	US
Telephone Number	:	605-338-2351
Fax Number	:	605-338-0241

Provider Business Practice Location Address
First Line	:	1901 S HOLLY AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-2407
Country	:	US
Telephone Number	:	605-338-2351
Fax Number	:	605-338-0241

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DENNIS FRED SEVER
Credential	:
Telephone Number	:	605-338-2351

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	10/20/2022

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Directions to “BETHANY LUTHERAN HOME ” Practice Location

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