Provider Demographics
NPI:1548225188
Name:SAMARITAN BETHANY INC
Entity Type:Organization
Organization Name:SAMARITAN BETHANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-289-5042
Mailing Address - Street 1:1530 ASSISI DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1637
Mailing Address - Country:US
Mailing Address - Phone:507-289-5042
Mailing Address - Fax:507-289-6545
Practice Address - Street 1:1530 ASSISI DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1637
Practice Address - Country:US
Practice Address - Phone:507-289-5042
Practice Address - Fax:507-289-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328445314000000X
MN328508314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8783BEOtherBC/BS HEIGHTS
MN8783BEOtherBC/BS HEIGHTS