Provider Demographics
NPI:1083279624
Name:BETHESDA HOME OF ABERDEEN, INC.
Entity Type:Organization
Organization Name:BETHESDA HOME OF ABERDEEN, INC.
Other - Org Name:BETHESDA TOWNE SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-225-7580
Mailing Address - Street 1:1224 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-7724
Mailing Address - Country:US
Mailing Address - Phone:605-225-7580
Mailing Address - Fax:605-225-7585
Practice Address - Street 1:1425 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-7726
Practice Address - Country:US
Practice Address - Phone:605-225-7580
Practice Address - Fax:605-225-7585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1487641395
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-09
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9575930Medicaid