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General NPI Number Information
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NPI Number | 1003807280
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Entity Type | Organization
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Legal Business Name | BETHANY LUTHERAN HOME
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7 ELLIOTT ST
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0239
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Country | US
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Telephone | 712-328-9500
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Fax | 712-309-0190
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Provider Business Mailing Address
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Address Line | 7 ELLIOTT ST
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0239
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Country | US
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Telephone | 712-328-9500
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Fax | 712-309-0190
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL VAN SICKLE
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Credential |
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Telephone | 712-328-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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