Provider Demographics
NPI:1497721880
Name:BETHESDA LONG TERM CARE, INC.
Entity Type:Organization
Organization Name:BETHESDA LONG TERM CARE, INC.
Other - Org Name:BETHESDA DILWORTH ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRINKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-800-1986
Mailing Address - Street 1:9645 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6521
Mailing Address - Country:US
Mailing Address - Phone:314-968-5460
Mailing Address - Fax:314-968-5253
Practice Address - Street 1:9645 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6521
Practice Address - Country:US
Practice Address - Phone:314-968-5460
Practice Address - Fax:314-968-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO593314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility