Organization
BETHANY BOARD AND LODGE, INC
Active
Other names
Grace Customized Living, New Horizon Customized Living, Bethany Assisted Living, Bethany In Home Services, Riverside Customized Living, Sunrise Customized Living, Bethany Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER MCGLYNN (PRESIDENT)
(218) 280-1609
Entity
Organization
Contact information
Practice address
903 HILLIGOSS BLVD SE SUITE B, FOSSTON, MN 56542
(218) 435-1044
(218) 435-1143
Mailing address
PO BOX 28, FOSSTON, MN 56542-0028
(218) 435-1044
(218) 435-1143
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
310400000X
Assisted Living Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A496997400
—
MN
05
—
A926615400
—
MN
Enumeration date
09/01/2016
Last updated
02/11/2019
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