# BETHANY ON 42ND

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043451123
- **Authorized official:** MR. SHAWN STUHAUG (PRESIDENT/CEO)
- **Authorized official phone:** (701) 239-3523

## Contact information

- **Practice address:** 201 UNIVERSITY DR S, FARGO, ND 58103-1775
- **Practice address phone:** (701) 239-3000
- **Practice address fax:** (701) 239-3237
- **Mailing address:** 4255 30TH AVE S, FARGO, ND 58104-8427
- **Mailing address phone:** (701) 239-3000
- **Mailing address fax:** (701) 239-3237

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/18/2009
- **Last updated:** 02/22/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1043451123 | — | MN |
| 05 | — | 30492 | — | ND |