Organization
BETHESDA LUTHERAN COMMUNITIES
Active
Other names
Faith Village III
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY A. KACZMARSKI (VP OF LEGAL AFFAIRS)
(920) 206-4406
Entity
Organization
Contact information
Practice address
14150 W 113TH ST, SHAWNEE MISSION, KS 66215-4819
(913) 906-5000
(913) 469-4028
Mailing address
14235 W 113 ST, SHAWNEE MISSION, KS 66215
(913) 906-5000
(913) 469-4028
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10010839D
—
KS
Enumeration date
12/18/2008
Last updated
02/05/2013
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