1033497078 NPI number — BETHESDA FOUNDATION, INC.

Table of content: (NPI 1033497078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033497078 NPI number — BETHESDA FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHESDA FOUNDATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
QUIETWATERS MINISTRIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033497078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9185 E KENYON AVE
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-1822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-639-9066
Provider Business Mailing Address Fax Number:
303-300-6773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 E PONDEROSA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80138-8268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-639-9066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHLOTTMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
303-639-9066

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)