- Enrollment id
- O20050228000365
- Enrollment state
- ND
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1306830427
- Multiple npi flag
- N
- Ccn
- 355070
- Associate id
- 4082667217
- Organization name
- BETHEL LUTHERAN NURSING & REHABILITATION CENTER
- Incorporation date
- 1948-07-15
- Incorporation state
- ND
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Nursing home provider name
- BETHEL LUTHERAN NURSING & REHABILITATION CENTER
- Address line 1
- 1515 2ND W AVE
- City
- WILLISTON
- State
- ND
- Zip code
- 588014108