Organization
BETHANY BOARD AND LODGE, INC
Active
Other names
Riverside Customized Living
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER MCGLYNN (PRESIDENT)
(218) 280-1609
Entity
Organization
Contact information
Practice address
240 1ST ST NE, MCINTOSH, MN 56556
(218) 435-1044
(218) 435-1143
Mailing address
PO BOX 28, FOSSTON, MN 56542
(218) 435-1044
(218) 435-1143
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/27/2018
Last updated
11/27/2018
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