Provider Demographics
NPI:1154866853
Name:BETHEL HOUSE
Entity Type:Organization
Organization Name:BETHEL HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KOFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-891-0081
Mailing Address - Street 1:994 S HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6608
Mailing Address - Country:US
Mailing Address - Phone:520-721-1887
Mailing Address - Fax:520-344-8892
Practice Address - Street 1:9820 E PASEO SAN BERNARDO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5022
Practice Address - Country:US
Practice Address - Phone:520-891-0081
Practice Address - Fax:520-344-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5068323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility