Provider Demographics
NPI:1356883136
Name:BETHESDA ASSISTED LIVING
Entity type:Organization
Organization Name:BETHESDA ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE-NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-644-4507
Mailing Address - Street 1:3950 S 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4709
Mailing Address - Country:US
Mailing Address - Phone:561-433-9331
Mailing Address - Fax:561-433-8411
Practice Address - Street 1:3950 S 57TH AVE
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4709
Practice Address - Country:US
Practice Address - Phone:561-433-9331
Practice Address - Fax:561-433-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12894310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility