NPIMap

Organization Active NPI

Bethany Home

  • Nursing Facility/Intermediate Care Facility
  • Dubuque, IA
National Provider Identifier
1053405803
Registry record updated Oct 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
N-307 Issued in IA
Legal business name
BETHANY HOME
Practice address
1005 Lincoln Ave
Dubuque, IA 52001-3499
Phone
(563) 556-5233
Fax
(563) 556-3078
NPI assigned
Oct 3, 2006
Last updated
Oct 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Glinda Lee Manternach
Title
Administrator
Phone
(563) 556-5233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X N-307 IA Primary

Addresses

Primary practice location

1005 Lincoln Ave
Dubuque, IA 52001-3499

Mailing address

1005 Lincoln Ave
Dubuque, IA 52001-3499
Phone (563) 556-5233

Other identifiers 1

IdentifierTypeStateIssuer
0800219MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071113000608 IA Part A Provider - Skilled Nursing Facility 4688762354 Practice locations: Dubuque, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053405803. Details of each certification follow.

Skilled nursing facility certification: CCN 165584

Legal name
BETHANY HOME
Doing business as
BETHANY HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 17, 2009
Last certification
May 1, 2025
Beds
66
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
1005 Lincoln Ave
Dubuque, IA 52001-3458
Nursing home name
BETHANY HOME

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bethany HomeCCN 165584 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 17, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6663.1 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0887301Bethany Home1005 Lincoln Avenue, Dubuque, IA 52001Certificate of waiverJun 8, 2028

National Provider Directory

National Provider Directory

Locations

1005 Lincoln Ave
Dubuque, IA 52001
Phone (563) 556-5233

Ownership & related parties

All disclosed owners & managing parties 49

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Janet Hayertz Individual Corporate OfficerVice President May 1, 2025
Individual Adp of the SNF May 1, 2013
Ces Computers Inc Organization, Dubuque, IA Corporation Adp of the SNF May 1, 2013
Individual Adp of the SNF Aug 1, 2023
Individual Adp of the SNF Aug 1, 2023
Tami Lansing Individual Operational/Managerial Control Feb 3, 2025
Benjamin Roush Individual Corporate DirectorDirector May 1, 2025
Allen G. Meurer Individual Corporate DirectorDirector Jul 1, 2024
Mike Brannon Individual Corporate OfficerPresident May 1, 2025
Individual Adp of the SNF Jan 1, 2019
Susan Chapman Individual Corporate DirectorDirector Mar 30, 2015
Individual Adp of the SNF Aug 1, 2023
Individual Adp of the SNF Aug 1, 2023
Individual Adp of the SNF Oct 1, 2024
Jill M Powers Individual Operational/Managerial Control Mar 1, 2024
Adp of the SNF Nov 1, 2025
Individual Adp of the SNF Jan 1, 2019
Shannon Brimeyer Individual Operational/Managerial Control Mar 28, 2007
Individual Adp of the SNF Aug 1, 2023
Individual Adp of the SNF Aug 1, 2023
Individual Adp of the SNF Aug 1, 2023
Sierra Gaul Individual Operational/Managerial Control Feb 14, 2020
BCG Holdings Inc Organization Corporation Adp of the SNF Oct 1, 2024
Dana Klein Individual Operational/Managerial Control Oct 23, 2012
Susan L Westmark Individual Operational/Managerial Control Sep 10, 1994
Adp of the SNF Nov 1, 2025
Richard Stender Individual Corporate DirectorDirector Jul 1, 2019 8.3%
Individual Adp of the SNF Jan 1, 2019
Individual Adp of the SNF Aug 1, 2023
Individual Adp of the SNF Aug 1, 2023
Joan Hoerner Individual Operational/Managerial Control May 19, 1992
Individual Adp of the SNF Aug 1, 2023
Rebecca Atkinson Individual Operational/Managerial Control Feb 13, 2003
John Goodman Individual Corporate DirectorDirector May 1, 2025
Kenneth Miller Individual Corporate OfficerTreasurer Mar 30, 2015
Individual Adp of the SNF Jan 1, 2019
Mercy Health Services-Iowa Corp Organization, Des Moines, IA Corporation, Medical provider/supplier Adp of the SNF Dec 1, 1995
Marsha Wilfong Individual Corporate OfficerSecretary Apr 21, 2022
Dori Edwards Individual Corporate DirectorDirector May 1, 2025
Millennium Rehab & Consulting Inc Organization, Des Moines, IA Corporation, Consulting firm Adp of the SNF Jan 1, 2019
Sara Loetscher Individual Corporate DirectorDirector Jul 1, 2019
Williams & Company PC Organization, Onawa, IA Corporation, Consulting firm Adp of the SNF Aug 1, 2023
Individual Adp of the SNF Aug 1, 2023
Individual Adp of the SNF Aug 1, 2023
Michael Molony Individual Adp of the SNF May 1, 2013
Individual Adp of the SNF Oct 1, 2024
Todd Stevensen Individual Corporate DirectorDirector May 1, 2025
Rebecca a Hilby Individual Adp of the SNF May 1, 2006
Individual Adp of the SNF Jan 1, 2019
Lawrence Middleman Individual Operational/Managerial Control Oct 1, 1993
Brighton Consulting Group LLC Organization, Urbandale, IA LLC Adp of the SNF Oct 1, 2024

Owners & managing parties with NPI records 16

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 16

Practitioners & affiliated clinicians

Affiliated clinicians 8

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223510400000",
    "number": "1053405803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 LINCOLN AVE",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520013499",
            "telephone_number": "563-556-5233",
            "fax_number": "563-556-3078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 LINCOLN AVE",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520013499",
            "telephone_number": "563-556-5233",
            "fax_number": "563-556-3078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-10-09",
        "status": "A",
        "authorized_official_last_name": "MANTERNACH",
        "authorized_official_first_name": "GLINDA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "563-556-5233",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IA",
            "license": "N-307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800219",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dubuque, IA

Sources for this page

Verify at the official NPI Registry.