Provider Demographics
NPI:1942341623
Name:BETHESDA FOUNDATION
Entity Type:Organization
Organization Name:BETHESDA FOUNDATION
Other - Org Name:AUTUMN VIEW 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 1:16219 AUTUMN VIEW TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4743
Mailing Address - Country:US
Mailing Address - Phone:636-458-5225
Mailing Address - Fax:636-458-0189
Practice Address - Street 1:16219 AUTUMN VIEW TERRACE DR
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-4743
Practice Address - Country:US
Practice Address - Phone:636-458-5225
Practice Address - Fax:636-458-0189
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
MO032753310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility