Healthcare Provider Details

I. General information

NPI: 1811814858
Provider Name (Legal Business Name): BETHESDA GROUP HOME AND STAFFING AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 ROWND ST
CEDAR FALLS IA
50613-6148
US

IV. Provider business mailing address

4016 ROWND ST
CEDAR FALLS IA
50613-6148
US

V. Phone/Fax

Practice location:
  • Phone: 319-240-3742
  • Fax:
Mailing address:
  • Phone: 319-240-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CODJOVI SEDJRO HOUANDJA
Title or Position: CO-OWNER
Credential:
Phone: 319-240-3742