1447257449 NPI number — BETHANY OPERATING CO LLC

Table of content: (NPI 1447257449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447257449 NPI number — BETHANY OPERATING CO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHANY OPERATING CO LLC
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:
Provider Other Organization Name Type Code:
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:
1447257449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W CHESTNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13440-2364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-339-3210
Provider Business Mailing Address Fax Number:
315-339-6927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13440-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-339-3210
Provider Business Practice Location Address Fax Number:
315-339-6927
Provider Enumeration Date:
07/05/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEWIRTZ
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL OVERSIGHT
Authorized Official Telephone Number:
914-588-8379

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  003201303N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00312785 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003201303N . This is a "OPERATING CERTIFICATE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0594 . This is a "PFI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".