Provider Demographics
NPI:1346683745
Name:BETHANY ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:BETHANY ASSISTED LIVING, INC.
Other - Org Name:WALDEN COURT ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO, EX DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THEISS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:325-247-5470
Mailing Address - Street 1:701 E YOUNG
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-1404
Mailing Address - Country:US
Mailing Address - Phone:325-247-5470
Mailing Address - Fax:325-247-3470
Practice Address - Street 1:701 E. YOUNG
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-1404
Practice Address - Country:US
Practice Address - Phone:325-247-5470
Practice Address - Fax:325-247-3470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY ASSISTED LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135748364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Single Specialty