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General NPI Number Information
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NPI Number | 1982790416
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Entity Type | Organization
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Legal Business Name | BETHESDA LUTHERAN HOMES AND SERVICES, INC.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 HOFFMANN DR
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City | WATERTOWN
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State | WI
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Zip | 53094
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Country | US
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Telephone | 920-261-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 700 HOFFMANN DR
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City | WATERTOWN
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State | WI
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Zip | 53094
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Country | US
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Telephone | 920-261-3050
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Fax |
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Authorized Official
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Title or Position | CHIEF LEGAL AFFAIRS OFFICER
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Name | 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 | 1060
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License Number State | WI
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