Healthcare Provider Details

I. General information

NPI: 1376842211
Provider Name (Legal Business Name): BETHESDA LONG TERM CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5943 TELEGRAPH RD
SAINT LOUIS MO
63129-4715
US

IV. Provider business mailing address

5943 TELEGRAPH RD
SAINT LOUIS MO
63129-4715
US

V. Phone/Fax

Practice location:
  • Phone: 314-846-2000
  • Fax: 314-846-2004
Mailing address:
  • Phone: 314-846-2000
  • Fax: 314-846-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH J BRINKER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 314-800-1986