Provider Demographics
NPI:1699029322
Name:BETTENDORF HEALTHCARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:BETTENDORF HEALTHCARE MANAGEMENT LLC
Other - Org Name:BETTENDORF HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-812-2550
Mailing Address - Street 1:2730 CROW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2066
Mailing Address - Country:US
Mailing Address - Phone:563-332-7463
Mailing Address - Fax:563-332-7464
Practice Address - Street 1:2730 CROW CREEK RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2066
Practice Address - Country:US
Practice Address - Phone:563-332-7463
Practice Address - Fax:563-332-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA820880314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165280Medicare Oscar/Certification