Provider Demographics
NPI:1821859620
Name:BETHANY ADULT DAY SERVICES, LLC
Entity Type:Organization
Organization Name:BETHANY ADULT DAY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUEENCILIA EDMOND
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:NGANDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-251-6442
Mailing Address - Street 1:505 N DUBUQUE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-5792
Mailing Address - Country:US
Mailing Address - Phone:605-251-6442
Mailing Address - Fax:
Practice Address - Street 1:3321 E 26TH ST STE 4
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-4144
Practice Address - Country:US
Practice Address - Phone:605-251-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care