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General NPI Number Information
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NPI Number | 1346683745
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Entity Type | Organization
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Legal Business Name | BETHANY ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 701 E. YOUNG
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City | LLANO
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State | TX
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Zip | 78643-1404
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Country | US
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Telephone | 325-247-5470
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Fax | 325-247-3470
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Provider Business Mailing Address
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Address Line | 701 E YOUNG
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City | LLANO
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State | TX
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Zip | 78643-1404
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Country | US
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Telephone | 325-247-5470
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Fax | 325-247-3470
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Authorized Official
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Title or Position | PRESIDENT, CEO, EX DIRECTOR
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Name | MS. LINDA ANN THEISS
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Credential | BSW
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Telephone | 325-247-5470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SL0600X
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Taxonomy Name | Long-Term Care Clinical Nurse Specialist
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License Number | 135748
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License Number State | TX
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