# BETHANY HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053405803
- **Authorized official:** MS. GLINDA LEE MANTERNACH (ADMINISTRATOR)
- **Authorized official phone:** (563) 556-5233

## Contact information

- **Practice address:** 1005 LINCOLN AVE, DUBUQUE, IA 52001-3499
- **Practice address phone:** (563) 556-5233
- **Practice address fax:** (563) 556-3078
- **Mailing address:** 1005 LINCOLN AVE, DUBUQUE, IA 52001-3499
- **Mailing address phone:** (563) 556-5233
- **Mailing address fax:** (563) 556-3078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | N-307 | IA | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 10/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0800219 | — | IA |