Provider Demographics
NPI:1033113626
Name:BETHESDA
Entity Type:Organization
Organization Name:BETHESDA
Other - Org Name:BETHESDA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-214-5603
Mailing Address - Street 1:1604 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4243
Mailing Address - Country:US
Mailing Address - Phone:320-235-8364
Mailing Address - Fax:
Practice Address - Street 1:901 WILLMAR AVE SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4604
Practice Address - Country:US
Practice Address - Phone:320-235-9532
Practice Address - Fax:320-235-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02926251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN476315700Medicaid
MN150979OtherUCARE
MN9845BEOtherBCBS & BLUE PLUS
MN476315700Medicaid