Organization
BETHANY ON 42ND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN STUHAUG (PRESIDENT/CEO)
(701) 239-3523
Entity
Organization
Contact information
Practice address
201 UNIVERSITY DR S, FARGO, ND 58103-1775
(701) 239-3000
(701) 239-3237
Mailing address
4255 30TH AVE S, FARGO, ND 58104-8427
(701) 239-3000
(701) 239-3237
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043451123
—
MN
05
—
30492
—
ND
Enumeration date
03/18/2009
Last updated
02/22/2010
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