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General NPI Number Information
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NPI Number | 1982745667
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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 | 01/27/2010
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Provider Practice Location Address
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Address Line | 11210 SCHUETZ RD
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4933
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Country | US
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Telephone | 314-993-9888
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Fax | 314-993-0005
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Provider Business Mailing Address
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Address Line | 11210 SCHUETZ RD
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4933
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Country | US
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Telephone | 314-993-9888
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Fax | 314-993-0005
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Authorized Official
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Title or Position | SR. VICE PRESIDENT
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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 | 032625
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License Number State | MO
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