1447464565 NPI number — BETHESDA LUTHERAN HOMES & SERVICES, INC.

Table of content: (NPI 1447464565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447464565 NPI number — BETHESDA LUTHERAN HOMES & SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHESDA LUTHERAN HOMES & SERVICES, 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:
Provider Other Organization Name Type Code:
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:
1447464565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 HOFFMANN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53094-6223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-261-3050
Provider Business Mailing Address Fax Number:
920-206-7711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2608 AURORA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64468-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-582-7371
Provider Business Practice Location Address Fax Number:
660-582-2791
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTON
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ACCOUNTING
Authorized Official Telephone Number:
920-206-4458

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 856243100 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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