BETHANY HOME – Nursing Facility/Intermediate Care Facility, NPI 1053405803

BETHANY HOME is a healthcare provider. based in Dubuque, Iowa. specializing in Nursing Facility/Intermediate Care Facility. The organization holds a License No. N-307 (IA). The NPI Number for BETHANY HOME is 1053405803

Main info

Organization
Name
BETHANY HOME
NPI
1053405803
Phone
(563) 556-5233
Address
1005 LINCOLN AVE
Authorized Official
MS. GLINDA LEE MANTERNACH ADMINISTRATOR
Enumeration Date
3 October 2006
Last Update Date
9 October 2008
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

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Provider Addresses for BETHANY HOME

  • 1005, Lincoln Avenue, Eagle Point District, Eagle Point, Dubuque, Dubuque County, Iowa, 52001, United States

    DUBUQUE, IA 520013499

    Phone: (563) 556-5233

    Fax: (563) 556-3078

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2007-11-13

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20071113000608OSkilled Nursing FacilityIATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 52001)

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Reviews

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Frequently asked questions

Can I use this page to confirm BETHANY HOME's NPI?
Yes. BETHANY HOME is listed with NPI 1053405803 in the public NPI dataset.
Does CMS list BETHANY HOME as active?
Yes — BETHANY HOME is active in the NPI listing used on this page.
What taxonomy line describes BETHANY HOME?
For research purposes, treat BETHANY HOME as Nursing Facility/Intermediate Care Facility in this dataset. Clinical services aligned with this taxonomy classification.
What area does BETHANY HOME serve?
BETHANY HOME's listing highlights Dubuque, Iowa; more addresses can appear in NPPES.
What does 'Organization' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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