Provider Demographics
NPI:1245242676
Name:BETHANY CARE CENTER L.L.C
Entity Type:Organization
Organization Name:BETHANY CARE CENTER L.L.C
Other - Org Name:METRON OF BLOOMINGDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:DOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-975-5287
Mailing Address - Street 1:3075 ORCHARD VISTA DR SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7069
Mailing Address - Country:US
Mailing Address - Phone:616-957-3957
Mailing Address - Fax:616-957-1556
Practice Address - Street 1:42235 COUNTY ROAD 390
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:MI
Practice Address - Zip Code:49026-8753
Practice Address - Country:US
Practice Address - Phone:269-521-3383
Practice Address - Fax:269-521-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI804010314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9742OtherBLUE CROSS
MI3018617Medicaid
MI3018617Medicaid