Healthcare Provider Details

I. General information

NPI: 1972153187
Provider Name (Legal Business Name): BETHESDA COMMUNITY SENIOR CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 W FOND DU LAC AVE
MILWAUKEE WI
53210-2628
US

IV. Provider business mailing address

2845 W FOND DU LAC AVE
MILWAUKEE WI
53210-2628
US

V. Phone/Fax

Practice location:
  • Phone: 414-788-9172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOSEA BATES
Title or Position: PASTOR/DIRECTOR
Credential:
Phone: 414-788-9172