MEDICARE: BETHESDA GARDENS CARROLLTON LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1740135508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA GARDENS CARROLLTON LLC

Provider Business Mailing Address
First Line	:	15475 GLENEAGLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2596
Country	:	US
Telephone Number	:	719-249-8545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 SEMINOLE TRL
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-6200
Country	:	US
Telephone Number	:	469-430-1234
Fax Number	:

Authorized Official
Title or Position	:	CHIEF LEGAL AND RISK OFFICER
Name	:	AUSTIN HARBACH
Credential	:
Telephone Number	:	719-640-7757

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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