BETHANY ON THE LAKE LLC (NPI# 1609380500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609380500 |
| Entity Type | Organization |
| Organization Name | BETHANY ON THE LAKE LLC |
| Practice Address |
1020 Lark St Alexandria MN 56308-2219 |
| Mailing Address |
638 Southbend Ave Mankato MN 56001-2168 |
| Practice Telephone | 3207621567 |
| Mailing Telephone | 5076975674 |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2019-10-16 |
| Authorized Official Name | JOSHUA LEGUM (CEO) |
| Authorized Official Telephone | 5076258741 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Street Address |
1020 LARK ST |
| City | ALEXANDRIA |
| State | MN |
| Zip Code | 56308-2219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154455343 | Ecumen | Skilled Nursing Facility | 1020 Lark St, Alexandria, MN 56308-2219 | 2007-03-16 |
| 1235585084 | Ecumen | Home Health | 1020 Lark St, Alexandria, MN 56308-2219 | 2016-05-11 |
| 1629436225 | Maralee Karen Moen | Occupational Therapy Assistant | 1020 Lark St, Alexandria, MN 56308-2269 | 2016-02-10 |
| 1790143980 | Lukas Wavra | Occupational Therapist | 1020 Lark St, Alexandria, MN 56308-2219 | 2016-02-03 |
| 1407186158 | Ecumen Properties Inc. | Assisted Living Facility | 1020 Lark St, Alexandria, MN 56308-2219 | 2009-12-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871104836 | Center for Pain Management Ambulatory Surgery, Ltd | Pain Medicine | 804 23rd Street South, Sartell, MN 56308 | 2020-08-13 |
| 1548815590 | Ritajo Ellenberger | Licensed Practical Nurse | 220 Oak Street North, Alexandria, MN 56308 | 2019-08-06 |
| 1346808714 | Vance Thompson Vision Surgery Center Alexandria, Prof LLC | Clinic/Center | 2600 Jefferson St, Alexandria, MN 56308 | 2019-05-31 |
| 1811452048 | Little Falls Eye Care Center Pa | Optometrist | 2306 S. Broadway Str. Suite 12, Alexandria, MN 56308 | 2019-02-01 |
| 1184167199 | Jennifer Lynn Craig | Technician | 2307 East Golf Course Rd, Alexandria, MN 56308 | 2016-11-22 |
| 1548712219 | Shelby Elisha Johnsrud | Chiropractor | 303 West 22nd Ave, Ste 100, Alexandria, MN 56308 | 2016-10-28 |
| 1811347867 | Dustin Matthew Ditch | Dentist | 510 22nd Ave E Ste 702, Alexandria, MN 56308 | 2016-06-20 |
| 1639538051 | West Central Chiropractic & Wellness, LLC | Chiropractor | 123 3rd Ave. E, Suite 100, Alexandria, MN 56308 | 2016-02-12 |
| 1659736221 | Amanda Jean Dahlseng | Registered Nurse | 809 Elm Street, Suite 1200, Alexandria, MN 56308 | 2015-12-23 |
| 1518358886 | Benjamin G Wenzel | Marriage & Family Therapist | 512 30th Ave S, Ste 100, Alexandria, MN 56308 | 2015-02-09 |
| Find all providers in zip 56308 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154455343 | Ecumen | Skilled Nursing Facility | 1020 Lark St, Alexandria, MN 56308-2219 | 2007-03-16 |
| 1336298470 | Baptist Convalescent Center, Inc. | Skilled Nursing Facility | 7341 E Alexandria Pike, Alexandria, KY 41001-1037 | 2007-01-09 |
| 1245399500 | Witham Memorial Hospital | Skilled Nursing Facility | 1912 S Park Ave, Alexandria, IN 46001-8193 | 2006-12-06 |
| 1033207162 | St Frances Nursing & Rehabilitation Center | Skilled Nursing Facility | 3844 Independence Dr, Alexandria, LA 71303-3533 | 2006-10-11 |
| 1972524858 | Fmrm,llc | Skilled Nursing Facility | 5100 Jackson Street Ext, Alexandria, LA 71303-2317 | 2006-07-23 |
| 1104861673 | Manor Care of Alexandria Va LLC | Skilled Nursing Facility | 1510 Collingwood Rd, Alexandria, VA 22308-1605 | 2006-06-18 |
| 1467490912 | Lexington House LLC | Skilled Nursing Facility | 16 Heyman Ln, Alexandria, LA 71303-3523 | 2006-06-04 |
| 1912950924 | Fountains Washington House Sl, LLC | Skilled Nursing Facility | 5100 Fillmore Ave, Alexandria, VA 22311-5069 | 2006-05-19 |
| 1356399299 | Community Care Center of Alexandria, LLC | Skilled Nursing Facility | 3343 Masonic Drive, Alexandria, LA 71301-3898 | 2006-05-04 |
| 1689649790 | Knute Nelson | Skilled Nursing Facility | 420 12th Ave E, Alexandria, MN 56308-2612 | 2006-02-22 |
| Find all providers in ALEXANDRIA | ||||
| City | ALEXANDRIA |
| Zip Code | 56308 |
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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.