Provider Demographics
NPI:1346675378
Name:BETHANY CHRISTIAN SERVICES
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKSTRA-POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-703-4371
Mailing Address - Street 1:12-19 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1843
Mailing Address - Country:US
Mailing Address - Phone:201-703-4371
Mailing Address - Fax:201-703-4376
Practice Address - Street 1:12-19 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1843
Practice Address - Country:US
Practice Address - Phone:201-703-4371
Practice Address - Fax:201-703-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002737001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty