Provider Demographics
NPI:1295042752
Name:BETHANY'S GAIT INC.
Entity Type:Organization
Organization Name:BETHANY'S GAIT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERBERG-ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-318-3498
Mailing Address - Street 1:27762 ANTONIO PKWY # L1-464
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1140
Mailing Address - Country:US
Mailing Address - Phone:714-318-3498
Mailing Address - Fax:
Practice Address - Street 1:27252 CALLE ARROYO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2745
Practice Address - Country:US
Practice Address - Phone:714-318-3498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-06
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty