Provider Demographics
NPI:1487641395
Name:BETHESDA HOME OF ABERDEEN, INC.
Entity type:Organization
Organization Name:BETHESDA HOME OF ABERDEEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-225-7580
Mailing Address - Street 1:1224 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-7724
Mailing Address - Country:US
Mailing Address - Phone:605-225-7580
Mailing Address - Fax:605-225-7585
Practice Address - Street 1:1224 S HIGH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-7724
Practice Address - Country:US
Practice Address - Phone:605-225-7580
Practice Address - Fax:605-225-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10589314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0150700Medicaid
SD0733230001OtherNATIONAL SUPPLIER CLEARIN
SD0150700Medicaid