NPIMap

Organization Active NPI

Bethesda Lutheran Communities

Doing business as Bethesda Faith Village

  • Mental Illness Intermediate Care Facility
  • Shawnee Mission, KS
National Provider Identifier
1265587356
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
1141302101 Issued in KS
Legal business name
BETHESDA LUTHERAN COMMUNITIES
Doing business as
Bethesda Faith Village
Practice address
14150 W 113TH St
Shawnee Mission, KS 66215-4819
Phone
(913) 906-5009
Fax
(913) 469-4028
NPI assigned
Jan 25, 2007
Last updated
May 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Authorized official

Name
Jeffrey A. Kaczmarski
Title
Chief Legal Affairs Officer
Phone
(920) 206-4406

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 0841302101 KS
Mental Illness Intermediate Care Facility 310500000X 1141302101 KS Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X KS

Addresses

Primary practice location

14150 W 113TH St
Shawnee Mission, KS 66215-4819

Mailing address

14150 W 113TH St
Shawnee Mission, KS 66215-4819
Phone (913) 906-9009

Other identifiers 6

IdentifierTypeStateIssuer
100108390CMedicaidKS
100045140EMedicaidKS
100045140DMedicaidKS
100045140KMedicaidKS
100108390BMedicaidKS
100108390DMedicaidKS

Other names 1

  • Bethesda Faith Village Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ablelight Inc29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1265587356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14150 W 113TH ST",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662154819",
            "telephone_number": "913-906-9009",
            "fax_number": "913-469-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14150 W 113TH ST",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662154819",
            "telephone_number": "913-906-5009",
            "fax_number": "913-469-4028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHESDA LUTHERAN COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "KACZMARSKI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CHIEF LEGAL AFFAIRS OFFICER",
        "authorized_official_telephone_number": "920-206-4406"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "KS",
            "license": "0841302101",
            "primary": false
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "KS",
            "license": "1141302101",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "KS",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100108390C",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100045140E",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100045140D",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100045140K",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100108390B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100108390D",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethesda Faith Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawnee Mission, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.