Provider Demographics
NPI:1225035553
Name:MENNONITE BETHESDA SOCIETY, INC.
Entity Type:Organization
Organization Name:MENNONITE BETHESDA SOCIETY, INC.
Other - Org Name:BETHESDA HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-367-2291
Mailing Address - Street 1:408 E. MAIN ST.
Mailing Address - Street 2:BOX 37
Mailing Address - City:GOESSEL
Mailing Address - State:KS
Mailing Address - Zip Code:67053-0037
Mailing Address - Country:US
Mailing Address - Phone:620-367-2291
Mailing Address - Fax:620-367-2294
Practice Address - Street 1:408 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:GOESSEL
Practice Address - State:KS
Practice Address - Zip Code:67053-0037
Practice Address - Country:US
Practice Address - Phone:620-367-2291
Practice Address - Fax:620-367-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-057-006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175403Medicare Oscar/Certification