MEDICARE: BETHEL 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	10644	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

General Provider Information

NPI Number	:	1497736615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL LUTHERAN HOME

Provider Business Mailing Address
First Line	:	1001 S EGAN AVE
Second Line	:
City	:	MADISON
State	:	SD
Zip	:	57042-3336
Country	:	US
Telephone Number	:	605-256-4539
Fax Number	:	605-256-4007

Provider Business Practice Location Address
First Line	:	1001 S EGAN AVE
Second Line	:
City	:	MADISON
State	:	SD
Zip	:	57042-3336
Country	:	US
Telephone Number	:	605-256-4539
Fax Number	:	605-256-4007

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JAMES T IVERSON
Credential	:
Telephone Number	:	605-256-4936

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/22/2020

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Directions to “BETHEL LUTHERAN HOME ” Practice Location

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