Provider Demographics
NPI:1326189960
Name:BETHESDA FOUNDATION
Entity Type:Organization
Organization Name:BETHESDA FOUNDATION
Other - Org Name:THE GARDENS INDEPENDENT LIVING
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 1:2730 S NETTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5971
Mailing Address - Country:US
Mailing Address - Phone:417-881-1330
Mailing Address - Fax:
Practice Address - Street 1:2730 S NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5971
Practice Address - Country:US
Practice Address - Phone:417-881-1330
Practice Address - Fax:
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
MO9837310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility