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General NPI Number Information
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NPI Number | 1689715351
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Entity Type | Organization
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Legal Business Name | BETHESDA FOUNDATION
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5417 ALTAMESA BLVD
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City | FORT WORTH
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State | TX
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Zip | 76123-2804
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Country | US
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Telephone | 817-292-8886
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Fax | 817-292-3128
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Provider Business Mailing Address
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Address Line | 5417 ALTAMESA BLVD
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City | FORT WORTH
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State | TX
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Zip | 76123-2804
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Country | US
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Telephone | 817-292-8886
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Fax | 817-292-3128
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Authorized Official
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Title or Position | SR. VICE PESIDENT
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Name | JULIE CALLENDER
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Credential |
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Telephone | 719-481-5481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 116869
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License Number State | TX
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