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General NPI Number Information
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NPI Number | 1780820977
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Entity Type | Organization
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Legal Business Name | BETHESDA LUTHERAN COMMUNITIES
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 14150 W 113TH ST
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City | SHAWNEE MISSION
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State | KS
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Zip | 66215-4819
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Country | US
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Telephone | 913-906-5000
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Fax | 913-469-4028
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Provider Business Mailing Address
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Address Line | 14175 W 113 ST
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City | SHAWNEE MISSION
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State | KS
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Zip | 66215
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Country | US
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Telephone | 913-906-5000
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Fax | 913-469-4028
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Authorized Official
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Title or Position | VP OF LEGAL AFFAIRS
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Name | MR. JEFFREY A. KACZMARSKI
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Credential |
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Telephone | 920-206-4406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | KS
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