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NPI Code Detail

MEDICARE: BETHANY HOME INC

MEDICARE: BETHANY HOME INC
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
1310400000XAssisted Living Facility1874WI
2314000000XSkilled Nursing Facility963WI

Other Identifiers

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

General Provider Information

NPI Number : 1215934963
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETHANY HOME INC
Provider Business Mailing Address
First Line : 1226 BERLIN ST
Second Line :
City : WAUPACA
State : WI
Zip : 54981-1991
Country : US
Telephone Number : 715-258-5521
Fax Number : 715-258-7051
Provider Business Practice Location Address
First Line : 1226 BERLIN ST
Second Line :
City : WAUPACA
State : WI
Zip : 54981-1991
Country : US
Telephone Number : 715-258-5521
Fax Number : 715-258-7051
Authorized Official
Title or Position : CEO
Name : GREGORY S REICHENBACH
Credential :
Telephone Number : 715-942-1400
Provider Enumeration Date : 07/07/2005
Last Update Date : 04/02/2025

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Directions to “BETHANY HOME INC ” Practice Location

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