Healthcare Provider Details

I. General information

NPI: 1083279624
Provider Name (Legal Business Name): BETHESDA HOME OF ABERDEEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 15TH AVE SE
ABERDEEN SD
57401-7726
US

IV. Provider business mailing address

1224 S HIGH ST
ABERDEEN SD
57401-7724
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-7580
  • Fax: 605-225-7585
Mailing address:
  • Phone: 605-225-7580
  • Fax: 605-225-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT EISENBEISZ
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 605-225-7580