Provider Demographics
NPI:1609181106
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:773-989-1465
Mailing Address - Fax:773-989-1377
Practice Address - Street 1:1550 S ALBANY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2212
Practice Address - Country:US
Practice Address - Phone:773-989-1465
Practice Address - Fax:773-989-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health