Provider Demographics
NPI:1578699500
Name:BETHANY RETIREMENT HOME, INC.
Entity Type:Organization
Organization Name:BETHANY RETIREMENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-378-6574
Mailing Address - Street 1:3005 WATKINS RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1800
Mailing Address - Country:US
Mailing Address - Phone:607-739-8711
Mailing Address - Fax:607-796-2566
Practice Address - Street 1:3005 WATKINS RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1800
Practice Address - Country:US
Practice Address - Phone:607-739-8711
Practice Address - Fax:607-796-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9305L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02057014Medicaid
NY01457556Medicaid