BETHANY BOARD AND LODGE, INC (NPI# 1114497773) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114497773 |
| Entity Type | Organization |
| Organization Name | BETHANY BOARD AND LODGE, INC |
| Practice Address |
203 S Inderlee Ave Fosston MN 56542 |
| Mailing Address |
Po Box 28 Fosston MN 56542 |
| Practice Telephone | 2184351044 |
| Practice Fax Number | 2184351143 |
| Mailing Telephone | 2184351044 |
| Mailing Fax Number | 2184351143 |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |
| Authorized Official Name | TYLER MCGLYNN (PRESIDENT) |
| Authorized Official Telephone | 2182801609 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Sunrise Customized Living | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942756556 | Bethany Board and Lodge, Inc | Assisted Living Facility | 903 Hilligoss Blvd Se Suite B, Fosston, MN 56542 | 2016-09-01 |
| 1669942298 | Bethany Board and Lodge, Inc | Assisted Living Facility | 240 1st St Ne, Mcintosh, MN 56556 | 2018-11-27 |
| Street Address |
203 S INDERLEE AVE |
| City | FOSSTON |
| State | MN |
| Zip Code | 56542 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942756556 | Bethany Board and Lodge, Inc | Assisted Living Facility | 903 Hilligoss Blvd Se Suite B, Fosston, MN 56542 | 2016-09-01 |
| 1407268642 | Prairie Pines Community | Assisted Living Facility | 903 Praire Pines Drive, Fosston, MN 56542 | 2014-05-22 |
| 1992115737 | Ekenesenarienrien Cynthia Omokaro | Family Medicine | Essentia Health Fosston Clinic, 900 Hilligoss Blvd. Se, Fosston, MN 56542 | 2014-05-02 |
| 1093944456 | Steven G. Lesmeister | Dentist | 105 2nd Street Sw, Mcintosh, MN 56542 | 2009-07-07 |
| 1427122811 | Kristi Lea Widseth | Nurse Anesthetist, Certified Registered | 900 Hilligoss Boulevard Se, Essentia Health Fosston, Fosston, MN 56542 | 2006-11-20 |
| 1184709685 | Todd William Sandwick | Dentist | 418 1st St. W., Fosston, MN 56542 | 2006-10-25 |
| 1487739975 | Kurt Anthony Albright | Dentist | 201 Hillestad Ave. Ne, Fosston, MN 56542 | 2006-10-25 |
| 1376033357 | Mallory Alice Vig | Occupational Therapist | 900 Hilligoss Blvd Se, Fosston, MN 56542 | 2018-05-15 |
| 1558851543 | Nicholas Chandler Woods | Nurse Practitioner | 900 Hilligoss Blvd Se, Fosston, MN 56542 | 2018-05-15 |
| 1215431853 | Christina Rose Leonard | Nurse Practitioner | 900 Hilligoss Blvd Se, Fosston, MN 56542 | 2018-03-20 |
| Find all providers in zip 56542 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942756556 | Bethany Board and Lodge, Inc | Assisted Living Facility | 903 Hilligoss Blvd Se Suite B, Fosston, MN 56542 | 2016-09-01 |
| 1407268642 | Prairie Pines Community | Assisted Living Facility | 903 Praire Pines Drive, Fosston, MN 56542 | 2014-05-22 |
| 1124051818 | Health Services Network, Inc | Assisted Living Facility | 115 1st St E, Fosston, MN 56542-1335 | 2006-07-08 |
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| 1710595863 | Eden Prairie Senior Living | Assisted Living Facility | 8480 Franlo Rd, Eden Prairie, MN 55344-2938 | 2020-07-15 |
| 1447868468 | Brightstar Services LLC | Assisted Living Facility | 1821 University Ave W Ste 120, Saint Paul, MN 55104-2811 | 2020-07-15 |
| 1235757667 | Roers Senior Living Buffalo LLC | Assisted Living Facility | 150 Division Street East, Buffalo, MN 55313 | 2020-07-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.