1619257037 NPI number — BETHANY CHRISTIAN SERVICES OF SOUTHERN CALIFORNIA

Table of content: (NPI 1619257037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619257037 NPI number — BETHANY CHRISTIAN SERVICES OF SOUTHERN CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHANY CHRISTIAN SERVICES OF SOUTHERN CALIFORNIA
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:
1619257037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16700 VALLEY VIEW AVE
Provider Second Line Business Mailing Address:
SUITE # 210
Provider Business Mailing Address City Name:
LA MIRADA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90638-5830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-994-0500
Provider Business Mailing Address Fax Number:
714-994-0515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16700 VALLEY VIEW AVE
Provider Second Line Business Practice Location Address:
SUITE # 210
Provider Business Practice Location Address City Name:
LA MIRADA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90638-5830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-994-0500
Provider Business Practice Location Address Fax Number:
714-994-0515
Provider Enumeration Date:
08/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
714-994-0500

Provider Taxonomy Codes

  • Taxonomy code: 253J00000X , with the licence number:  197804198 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com