Provider Demographics
NPI:1366865453
Name:BETHANY CHRISTIAN SERVICE
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-372-8800
Mailing Address - Street 1:6687 SEECO DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5970
Mailing Address - Country:US
Mailing Address - Phone:269-372-8800
Mailing Address - Fax:269-372-8855
Practice Address - Street 1:6687 SEECO DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5970
Practice Address - Country:US
Practice Address - Phone:269-372-8800
Practice Address - Fax:269-372-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010870241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty