Provider Demographics
NPI:1952456444
Name:BETHANY MANOR INC
Entity Type:Organization
Organization Name:BETHANY MANOR INC
Other - Org Name:BETHANY LIFE COMMUNITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARBURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-733-4325
Mailing Address - Street 1:212 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-1454
Mailing Address - Country:US
Mailing Address - Phone:515-733-4325
Mailing Address - Fax:515-733-5293
Practice Address - Street 1:212 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1454
Practice Address - Country:US
Practice Address - Phone:515-733-4325
Practice Address - Fax:515-733-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8502203140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0272575Medicaid
IA0454272Medicaid
IA0800235Medicaid
IA65424OtherWELLMARK
IA0618050001Medicare NSC
IA0272575Medicaid