Provider Demographics
NPI:1184712002
Name:MOUNTRAIL BETHEL HOME, INC.
Entity type:Organization
Organization Name:MOUNTRAIL BETHEL HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-682-2424
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-0700
Mailing Address - Country:US
Mailing Address - Phone:701-628-2442
Mailing Address - Fax:701-628-3990
Practice Address - Street 1:615 6TH ST SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-4444
Practice Address - Country:US
Practice Address - Phone:701-628-2442
Practice Address - Fax:701-628-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND030032Medicaid
ND1456667Medicaid