Provider Demographics
NPI:1609917368
Name:BETHESDA FOUNDATION
Entity Type:Organization
Organization Name:BETHESDA FOUNDATION
Other - Org Name:BETHESDA GARDENS
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 1:13825 N CAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6178
Mailing Address - Country:US
Mailing Address - Phone:602-765-4000
Mailing Address - Fax:602-765-4005
Practice Address - Street 1:13825 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6178
Practice Address - Country:US
Practice Address - Phone:602-765-4000
Practice Address - Fax:602-765-4005
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
AZACL2247310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ522939Medicaid