Provider Demographics
NPI:1356677413
Name:BETHESDA FAMILY SERVICE FOUNDATION
Entity Type:Organization
Organization Name:BETHESDA FAMILY SERVICE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:570-523-0605
Mailing Address - Street 1:88 BULL RUN XING
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6725
Mailing Address - Country:US
Mailing Address - Phone:570-523-0605
Mailing Address - Fax:570-523-0676
Practice Address - Street 1:88 BULL RUN XING
Practice Address - Street 2:SUITE ONE
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6725
Practice Address - Country:US
Practice Address - Phone:570-523-0605
Practice Address - Fax:570-523-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health