Provider Demographics
NPI:1689715351
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 PESIDENT
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 1:5417 ALTAMESA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2804
Mailing Address - Country:US
Mailing Address - Phone:817-292-8886
Mailing Address - Fax:817-292-3128
Practice Address - Street 1:5417 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2804
Practice Address - Country:US
Practice Address - Phone:817-292-8886
Practice Address - Fax:817-292-3128
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
TX116869310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility