Provider Demographics
NPI:1306830427
Name:BETHEL LUTHERAN NURSING & REHABILITATION CENTER
Entity Type:Organization
Organization Name:BETHEL LUTHERAN NURSING & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-572-6766
Mailing Address - Street 1:1515 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4108
Mailing Address - Country:US
Mailing Address - Phone:701-572-6766
Mailing Address - Fax:701-572-7579
Practice Address - Street 1:1515 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4108
Practice Address - Country:US
Practice Address - Phone:701-572-6766
Practice Address - Fax:701-572-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1058A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30038Medicaid
ND036675001OtherDME-POS SUPPLIER
ND35-5070Medicare PIN
ND036675001OtherDME-POS SUPPLIER
ND355070Medicare Oscar/Certification