Provider Demographics
NPI:1528040797
Name:BETHEL HOME, INC.
Entity Type:Organization
Organization Name:BETHEL HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-846-2241
Mailing Address - Street 1:300 S AZTEC ST
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:KS
Mailing Address - Zip Code:67867-8811
Mailing Address - Country:US
Mailing Address - Phone:620-846-2241
Mailing Address - Fax:620-846-2149
Practice Address - Street 1:300 S AZTEC ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:KS
Practice Address - Zip Code:67867-8811
Practice Address - Country:US
Practice Address - Phone:620-846-2241
Practice Address - Fax:620-846-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN035001313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility