Provider Demographics
NPI:1083754881
Name:BETHESDA FOUNDATION
Entity Type:Organization
Organization Name:BETHESDA FOUNDATION
Other - Org Name:HICKORY VILLA
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-481-5481
Mailing Address - Street 1:7315 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1677
Mailing Address - Country:US
Mailing Address - Phone:402-392-0767
Mailing Address - Fax:402-392-2371
Practice Address - Street 1:7315 HICKORY ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1677
Practice Address - Country:US
Practice Address - Phone:402-392-0767
Practice Address - Fax:402-392-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF080310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility