Healthcare Provider Details

I. General information

NPI: 1396990198
Provider Name (Legal Business Name): BETHESDA LUTHERAN HOMES & SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 RECKINGER RD
AURORA IL
60505-1624
US

IV. Provider business mailing address

600 HOFFMANN DR
WATERTOWN WI
53094-6223
US

V. Phone/Fax

Practice location:
  • Phone: 630-841-6777
  • Fax:
Mailing address:
  • Phone: 920-261-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY A KACZMARSKI
Title or Position: CLAO
Credential:
Phone: 920-206-4406