Provider Demographics
NPI:1538681549
Name:BETHESDA LUTHERAN COMMUNITIES
Entity Type:Organization
Organization Name:BETHESDA LUTHERAN COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-831-4088
Mailing Address - Street 1:220 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1802
Mailing Address - Country:US
Mailing Address - Phone:973-831-4088
Mailing Address - Fax:
Practice Address - Street 1:116 THACKERAY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-3320
Practice Address - Country:US
Practice Address - Phone:973-831-4088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities