BETHESDA FOUNDATION , NPI 1215077045 — CAMBRIDGE COURT in KEARNEY (NE)

NPI 1215077045

12+ Years Experience Organization

BETHESDA FOUNDATION

Other organization name: CAMBRIDGE COURT.

02.08.2007
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1215077045
NPI NUMBER

About BETHESDA FOUNDATION

BETHESDA FOUNDATION is a provider established in KEARNEY, NE. The NPI number of BETHESDA FOUNDATION is 1215077045 and was assigned on 02.08.2007. The practitioners primary taxonomy code is: 310400000X with license number: ALF024 CO .

Mailing address

  • City: KEARNEY
  • State: NE
  • Postal code: 688472532
  • Phone: 3082373773
  • Fax: 3082349832
  • Address: 4107 CENTRAL AVE

Primary Practice Address

  • Region : KEARNEY, NE
  • NPI : 1215077045
  • Phone : 3082373773
  • Fax : 3082349832
  • Postalcode : 688472532
  • Address : 4107 CENTRAL AVE

Provider taxonomy - Assisted Living Facility

  • Taxonomy code: 310400000X
  • License number: ALF024
  • License state: CO

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Contacts:

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  • BETHESDA FOUNDATION
  • Address : 4107 CENTRAL AVE
  • Region : KEARNEY, NE
  • NPI : 1215077045
  • Phone : 3082373773
  • Fax : 3082349832
  • Postalcode : 688472532

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 7194815481
  • Title or position : SR. VICE PRESIDENT

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address4107 CENTRAL AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameKEARNEY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameNE
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code688472532
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3082373773
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3082349832
The fax number associated with the location address of the provider being identified.
NPI1215077045
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1310400000X
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Provider Enumeration Date02.08.2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)BETHESDA FOUNDATION
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider Other Organization NameCAMBRIDGE COURT
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code5
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address4107 CENTRAL AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameKEARNEY
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameNE
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code688472532
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3082373773
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3082349832
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameCALLENDER
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameJULIE
The first name of the authorized official
Authorized Official Title or PositionSR. VICE PRESIDENT
The title or position of the authorized official
Authorized Official Telephone Number7194815481
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1310400000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Provider License Number 1ALF024
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1CO
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
X

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