Provider Demographics
NPI:1598815805
Name:BETH HAVEN GROUP HOMES INC
Entity Type:Organization
Organization Name:BETH HAVEN GROUP HOMES INC
Other - Org Name:KREIDER HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:EWERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-221-2258
Mailing Address - Street 1:2500 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2600
Mailing Address - Country:US
Mailing Address - Phone:573-221-2258
Mailing Address - Fax:
Practice Address - Street 1:2510 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2659
Practice Address - Country:US
Practice Address - Phone:573-221-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home