Provider Demographics
NPI:1083246714
Name:BETHANY CHRISTIAN SERVICES OF WV
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES OF WV
Other - Org Name:BETHANY CHRISTIAN SERIVES OF CENTRAL PA
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUTMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-224-7429
Mailing Address - Street 1:291 ROCK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2835
Mailing Address - Country:US
Mailing Address - Phone:304-620-2695
Mailing Address - Fax:304-620-5180
Practice Address - Street 1:101 MEDICAL CT STE 100
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3854
Practice Address - Country:US
Practice Address - Phone:304-620-2695
Practice Address - Fax:304-620-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty