Bethany Covenant Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NO NUMBERS USED Issued in MN

Legal business name

BETHANY COVENANT HOME

Doing business as

Bethany Covenant Village

Practice address

2309 Hayes St NE
Minneapolis, MN 55418-3934

Phone

(612) 781-2691

Fax

(612) 781-8835

NPI assigned

Sep 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Rick K Fisk

Title

President

Phone

(773) 878-2295

Specialties & licenses 1

Addresses

Other names 1

• Bethany Covenant Village Doing business as

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073618997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2309 HAYES ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554183934",
            "telephone_number": "612-781-2691",
            "fax_number": "612-781-8835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2309 HAYES ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554183934",
            "telephone_number": "612-781-2691",
            "fax_number": "612-781-8835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY COVENANT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FISK",
        "authorized_official_first_name": "RICK",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-878-2295",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "NO NUMBERS USED",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethany Covenant Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.