Provider Demographics
NPI:1033102165
Name:BETHANY HOME ASSOCIATION OF LINDSBORG KANSAS
Entity Type:Organization
Organization Name:BETHANY HOME ASSOCIATION OF LINDSBORG KANSAS
Other - Org Name:BETHANY HOME ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-227-2892
Mailing Address - Street 1:321 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456-1904
Mailing Address - Country:US
Mailing Address - Phone:785-227-2892
Mailing Address - Fax:785-227-3138
Practice Address - Street 1:321 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456-1904
Practice Address - Country:US
Practice Address - Phone:785-227-2892
Practice Address - Fax:785-227-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS100108780A313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1041589001Medicaid
KS420010Medicare ID - Type Unspecified