MEDICARE: NEW BETHANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	040000489	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083602304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BETHANY

Provider Business Mailing Address
First Line	:	1441 BERKELEY DR
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-9599
Country	:	US
Telephone Number	:	209-827-8949
Fax Number	:	209-827-6375

Provider Business Practice Location Address
First Line	:	1441 BERKELEY DR
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-9599
Country	:	US
Telephone Number	:	209-827-8949
Fax Number	:	209-827-6375

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LUCINDA FONSECA
Credential	:
Telephone Number	:	209-827-8933

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	10/20/2021

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Directions to “NEW BETHANY ” Practice Location

Language	Start Address	Practice Location

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