Provider Demographics
NPI:1083702047
Name:BETHANY HOMES AND METHODIST HOSPITAL
Entity Type:Organization
Organization Name:BETHANY HOMES AND METHODIST HOSPITAL
Other - Org Name:BETHANY TERRACE NURSING CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:REISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-989-1465
Mailing Address - Street 1:8425 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2202
Mailing Address - Country:US
Mailing Address - Phone:847-965-8100
Mailing Address - Fax:847-965-0114
Practice Address - Street 1:8425 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2202
Practice Address - Country:US
Practice Address - Phone:847-965-8100
Practice Address - Fax:847-965-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0015651314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL145198Medicare Oscar/Certification
IL0328600001Medicare NSC