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General NPI Number Information
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NPI Number | 1053405803
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Entity Type | Organization
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Legal Business Name | BETHANY HOME
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 1005 LINCOLN AVE
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City | DUBUQUE
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State | IA
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Zip | 52001-3499
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Country | US
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Telephone | 563-556-5233
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Fax | 563-556-3078
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Provider Business Mailing Address
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Address Line | 1005 LINCOLN AVE
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City | DUBUQUE
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State | IA
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Zip | 52001-3499
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Country | US
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Telephone | 563-556-5233
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Fax | 563-556-3078
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. GLINDA LEE MANTERNACH
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Credential |
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Telephone | 563-556-5233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | N-307
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License Number State | IA
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