1639412554 NPI number — BETHANY HEALTH CARE CENTER, INC.

Table of content: (NPI 1639412554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639412554 NPI number — BETHANY HEALTH CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHANY HEALTH CARE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BETHANY HEALTH CARE CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639412554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97 BETHANY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-7237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-872-6750
Provider Business Mailing Address Fax Number:
508-270-8601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 BETHANY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-7237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-872-6750
Provider Business Practice Location Address Fax Number:
508-270-8601
Provider Enumeration Date:
03/28/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DRYDEN
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
508-270-8673

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 0928 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)