Provider Demographics
NPI:1720041411
Name:BETHESDA HEALTH CARE CENTER LLC
Entity Type:Organization
Organization Name:BETHESDA HEALTH CARE CENTER LLC
Other - Org Name:RESTHAVEN MANOR INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-595-8383
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-0010
Mailing Address - Country:US
Mailing Address - Phone:731-847-6343
Mailing Address - Fax:731-847-4200
Practice Address - Street 1:444 ONE ELEVEN PL
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506
Practice Address - Country:US
Practice Address - Phone:931-525-6655
Practice Address - Fax:931-525-3581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH COMPANIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-11
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0379313M00000X
TN0000000189314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN744-0342Medicaid
TN445427Medicare Oscar/Certification