MEDICARE: BETHESDA

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1528770781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA

Provider Business Mailing Address
First Line	:	901 WILLMAR AVE SE
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-4604
Country	:	US
Telephone Number	:	320-235-9532
Fax Number	:	320-235-7909

Provider Business Practice Location Address
First Line	:	901 WILLMAR AVE SE
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-4604
Country	:	US
Telephone Number	:	320-235-9532
Fax Number	:	320-235-7909

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	ASHLEY BORMANN
Credential	:
Telephone Number	:	320-214-5662

Provider Enumeration Date	:	12/20/2022
Last Update Date	:	12/20/2022

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Directions to “BETHESDA ” Practice Location

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