Provider Demographics
NPI:1467953992
Name:BETHLEHEM LUTHERAN CHURCH
Entity Type:Organization
Organization Name:BETHLEHEM LUTHERAN CHURCH
Other - Org Name:BETHLEHEM INTERGENERATIONAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHUELKE-DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-456-7509
Mailing Address - Street 1:250 COMMERCE AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-456-7509
Mailing Address - Fax:616-456-1759
Practice Address - Street 1:250 COMMERCE AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-456-7509
Practice Address - Fax:616-456-1759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHLEHEM LUTHERAN CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care