Provider Demographics
NPI:1386631240
Name:BETHEL HOME AND SERVICES INC
Entity Type:Organization
Organization Name:BETHEL HOME AND SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-637-2171
Mailing Address - Street 1:614 S ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-1936
Mailing Address - Country:US
Mailing Address - Phone:608-637-2171
Mailing Address - Fax:608-637-8303
Practice Address - Street 1:614 S ROCK AVE
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1936
Practice Address - Country:US
Practice Address - Phone:608-637-2171
Practice Address - Fax:608-637-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20151800Medicaid
WI20151800Medicaid
WI525591Medicare ID - Type Unspecified