Provider Demographics
NPI:1255446415
Name:BETHEL LUTHERAN HOME, INC.
Entity type:Organization
Organization Name:BETHEL LUTHERAN HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIKHA
Authorized Official - Middle Name:SHALINI
Authorized Official - Last Name:PATTESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-896-4900
Mailing Address - Street 1:2280 DOCKERY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3806
Mailing Address - Country:US
Mailing Address - Phone:559-896-4900
Mailing Address - Fax:559-896-6842
Practice Address - Street 1:2280 DOCKERY AVENUE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3806
Practice Address - Country:US
Practice Address - Phone:559-896-4900
Practice Address - Fax:559-896-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100400043310400000X
CA040000077314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205315Medicaid