Organization
BETHESDA LUTHERAN COMMUNITIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN HOLTON (DIRECTOR OF ACCOUNTING SERVICES)
(920) 206-4458
Entity
Organization
Contact information
Practice address
5122 AMBERGLOW DR, SAINT LOUIS, MO 63129-3204
(920) 206-4458
Mailing address
600 HOFFMANN DR, WATERTOWN, WI 53094-6223
(920) 206-4458
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99533340
—
WI
Enumeration date
01/19/2012
Last updated
01/19/2012
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