Organization
BETHESDA LUTHERAN COMMUNITIES
Active
Other names
Bethesda Faith Village
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY A. KACZMARSKI (CHIEF LEGAL AFFAIRS OFFICER)
(920) 206-4406
Entity
Organization
Contact information
Practice address
14150 W 113TH ST, SHAWNEE MISSION, KS 66215-4819
(913) 906-5009
(913) 469-4028
Mailing address
14150 W 113TH ST, SHAWNEE MISSION, KS 66215-4819
(913) 906-9009
(913) 469-4028
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
0841302101
KS
310500000X
Mental Illness Intermediate Care Facility
Primary
1141302101
KS
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100045140D
—
KS
05
—
100045140E
—
KS
05
—
100045140K
—
KS
05
—
100108390B
—
KS
05
—
100108390C
—
KS
05
—
100108390D
—
KS
Enumeration date
01/25/2007
Last updated
05/11/2017
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