NPIMap

Organization Active NPI

Bethany Board and Lodge, Inc

Doing business as Sunrise Customized Living

  • Assisted Living Facility
  • Fosston, MN
National Provider Identifier
1114497773
Registry record updated Nov 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
BETHANY BOARD AND LODGE, INC
Doing business as
Sunrise Customized Living
Practice address
203 S Inderlee Ave
Fosston, MN 56542
Phone
(218) 435-1044
Fax
(218) 435-1143
NPI assigned
Nov 27, 2018
Last updated
Nov 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2018

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

Authorized official

Name
Tyler McGlynnNPI 1215467139
Title
President
Phone
(218) 280-1609

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU Primary

Addresses

Primary practice location

203 S Inderlee Ave
Fosston, MN 56542

Mailing address

PO Box 28
Fosston, MN 56542
Phone (218) 435-1044

Other names 1

  • Sunrise Customized Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bethany Board and Lodge Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543276800000",
    "number": "1114497773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "56542",
            "telephone_number": "218-435-1044",
            "fax_number": "218-435-1143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S INDERLEE AVE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "56542",
            "telephone_number": "218-435-1044",
            "fax_number": "218-435-1143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY BOARD AND LODGE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-27",
        "last_updated": "2018-11-27",
        "status": "A",
        "authorized_official_last_name": "MCGLYNN",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-280-1609"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise Customized Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fosston, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2018; 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.