Basic Information
| Provider Information | |||||||||
| NPI: | 1790055788 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETHANY CHRISTIAN SERVICES USA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 36TH ST SE | ||||||||
| Address2: | 400 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495085580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169658096 | ||||||||
| FaxNumber: | 6162547750 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 36TH ST SE | ||||||||
| Address2: | 400 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495085580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169658096 | ||||||||
| FaxNumber: | 6162547750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2012 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | DEVOS | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MICHIGAN DIRECTOR OF OPERATION | ||||||||
| AuthorizedOfficialTelephone: | 6162547717 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253J00000X | Y | Agencies | Foster Care Agency |
No ID Information.