MEDICARE: BETHESDA GROUP HOME AND STAFFING AGENCY 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1811814858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA GROUP HOME AND STAFFING AGENCY LLC

Provider Business Mailing Address
First Line	:	4016 ROWND ST
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-6148
Country	:	US
Telephone Number	:	319-240-3742
Fax Number	:

Provider Business Practice Location Address
First Line	:	4016 ROWND ST
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-6148
Country	:	US
Telephone Number	:	319-240-3742
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	CODJOVI SEDJRO HOUANDJA
Credential	:
Telephone Number	:	319-240-3742

Provider Enumeration Date	:	07/01/2026
Last Update Date	:	07/01/2026

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