Provider Demographics
NPI:1407993116
Name:BETHANY HOMES AND METHODIST HOSPITAL
Entity Type:Organization
Organization Name:BETHANY HOMES AND METHODIST HOSPITAL
Other - Org Name:METHODIST HOSPITAL OF CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:REISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-989-1465
Mailing Address - Street 1:5025 N PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2772
Mailing Address - Country:US
Mailing Address - Phone:773-271-9040
Mailing Address - Fax:773-271-2010
Practice Address - Street 1:5025 N PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2772
Practice Address - Country:US
Practice Address - Phone:773-271-9040
Practice Address - Fax:773-271-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000125314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145672Medicare Oscar/Certification