1780820977 NPI number — BETHESDA LUTHERAN COMMUNITIES

Table of content: (NPI 1780820977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780820977 NPI number — BETHESDA LUTHERAN COMMUNITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHESDA LUTHERAN COMMUNITIES
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:
6
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:
1780820977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14175 W 113 ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-906-5000
Provider Business Mailing Address Fax Number:
913-469-4028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14150 W 113TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAWNEE MISSION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66215-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-906-5000
Provider Business Practice Location Address Fax Number:
913-469-4028
Provider Enumeration Date:
12/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KACZMARSKI
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VP OF LEGAL AFFAIRS
Authorized Official Telephone Number:
920-206-4406

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100108390C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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