Provider Demographics
NPI:1942384318
Name:BETHANY HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:BETHANY HOME HEALTH CARE, INC.
Other - Org Name:BETHANY PERSONAL CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:STUHAUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-239-3000
Mailing Address - Street 1:201 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1775
Mailing Address - Country:US
Mailing Address - Phone:701-239-3000
Mailing Address - Fax:701-239-3546
Practice Address - Street 1:201 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1775
Practice Address - Country:US
Practice Address - Phone:701-239-3000
Practice Address - Fax:701-239-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND34316OtherDHS PROVIDER NUMBER