NPIMap

Organization Active NPI

Bethany on 42ND

  • Skilled Nursing Facility
  • Fargo, ND
National Provider Identifier
1043451123
Registry record updated Feb 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BETHANY ON 42ND
Practice address
201 University Dr S
Fargo, ND 58103-1775
Phone
(701) 239-3000
Fax
(701) 239-3237
NPI assigned
Mar 18, 2009
Last updated
Feb 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Shawn Stuhaug
Title
President/Ceo
Phone
(701) 239-3523

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

201 University Dr S
Fargo, ND 58103-1775

Mailing address

4255 30TH Ave S
Fargo, ND 58104-8427
Phone (701) 239-3000

Other identifiers 2

IdentifierTypeStateIssuer
1043451123MedicaidMN
30492MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090819000795 ND Part A Provider - Skilled Nursing Facility 0648324038 Practice locations: Fargo, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043451123. Details of each certification follow.

Skilled nursing facility certification: CCN 355123

Legal name
BETHANY ON 42ND
Doing business as
BETHANY RETIREMENT LIVING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 20, 2010
Last certification
May 1, 2025
Beds
116
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Bethany Retirement Living
Organization structure
CorporationNon-profit
Incorporated
Aug 20, 2007 in ND
Enrollment address
4255 30TH Ave S
Fargo, ND 58104-8427
Nursing home name
BETHANY ON 42ND

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bethany on 42NDCCN 355123 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jan 20, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
116113.5 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D1099200Bethany on 42ND4255 30TH Ave S, Fargo, ND 58104Certificate of waiverMay 6, 2027

National Provider Directory

National Provider Directory

Locations

201 University Dr S
Fargo, ND 58103
Phone (701) 239-3000

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joseph Wendt Individual Corporate DirectorBoard of Trustees May 13, 2025
Bethany on 42ND Organization, Fargo, ND Corporation, Non-profit Operational/Managerial Control Jan 14, 2010 100%
Adp of the SNF Jan 1, 2009
Bethany Homes, Inc Organization, Fargo, ND Non-profit Operational/Managerial Control Jan 1, 2009
Adp of the SNF Apr 10, 2025
Kaye Angus Individual Corporate OfficerChief Finanical Officer Oct 1, 2022
Operational/Managerial Control Oct 1, 2022
Adp of the SNF Oct 1, 2022
Blue Stone Therapy Inc Organization, Urbandale, IA Corporation Operational/Managerial Control May 1, 2019
Adp of the SNF Apr 4, 2025
Rick Steen Individual Corporate DirectorBoard Member Apr 9, 2024
Shawn a Stuhaug Individual Corporate OfficerPresident and Ceo Jun 23, 2009
Operational/Managerial Control Jun 23, 2009
Adp of the SNF Apr 9, 2007
Laura Ness Owens Individual Corporate DirectorBoard Member Apr 9, 2024
Bell Bank Arrowhead Office Organization, Fargo, ND Financial institution 5% Or Greater Mortgage Interest Apr 1, 2010 62%
Operational/Managerial Control Mar 1, 1996
Adp of the SNF Apr 1, 2010
Lianne Rockstad Individual Corporate DirectorBoard Member Apr 9, 2024
John Hertsgaard Individual Corporate DirectorBoard Member Apr 9, 2024
Cheryl Anderson Individual Corporate DirectorBoard Member Apr 18, 2023
Roger Olson Individual Corporate DirectorBoard Member Apr 19, 2022
Parul Gupta Individual Operational/Managerial Control Oct 1, 2020
Adp of the SNF Oct 1, 2020
Jack Rydell Individual Corporate DirectorBoard of Trustees May 13, 2025
Beth Renner Individual Corporate DirectorBoard Member Apr 18, 2023
Eide Bailly LLP Organization, Fargo, ND Consulting firm Operational/Managerial Control Jan 1, 1998
Adp of the SNF Apr 8, 2025
Jerilynn Brantner-Adams Individual Corporate DirectorBoard of Trustees Apr 18, 2023
Bruce L Davidson Individual Corporate DirectorBoard of Trustees May 13, 2025

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 25

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 25

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266796800000",
    "number": "1043451123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4255 30TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048427",
            "telephone_number": "701-239-3000",
            "fax_number": "701-239-3237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031775",
            "telephone_number": "701-239-3000",
            "fax_number": "701-239-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY ON 42ND",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-18",
        "last_updated": "2010-02-22",
        "status": "A",
        "authorized_official_last_name": "STUHAUG",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "701-239-3523",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043451123",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30492",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.