Provider Demographics
NPI:1760147037
Name:BETHESDA NORTH POINTE
Entity Type:Organization
Organization Name:BETHESDA NORTH POINTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-214-5662
Mailing Address - Street 1:901 WILLMAR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4604
Mailing Address - Country:US
Mailing Address - Phone:320-214-5662
Mailing Address - Fax:
Practice Address - Street 1:500 PETERSON PKWY
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273-7838
Practice Address - Country:US
Practice Address - Phone:320-235-9532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHESDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility