Organization
BETHESDA LUTHERAN HOMES AND SERVICES, INC.
Active
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
700 HOFFMANN DR, WATERTOWN, WI 53094
(920) 261-3050
Mailing address
700 HOFFMANN DR, WATERTOWN, WI 53094
(920) 261-3050
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
1060
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20132700
—
WI
Enumeration date
10/04/2006
Last updated
08/22/2020
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