MEDICARE: BETHANY MN MANAGEMENT, LLC

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

General Provider Information

NPI Number	:	1669863106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY MN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	7150 PARSONS BLVD STE 1001
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11365-4603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2309 HAYES ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3934
Country	:	US
Telephone Number	:	612-781-2691
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	PHILIP FRIEDMAN
Credential	:
Telephone Number	:	718-408-8954

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	04/07/2015

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