Provider Demographics
NPI:1689710121
Name:BETHSHAN ASSOCIATION
Entity Type:Organization
Organization Name:BETHSHAN ASSOCIATION
Other - Org Name:TIBSTRA HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOUDZWAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-371-0800
Mailing Address - Street 1:12927 S MONITOR AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2434
Mailing Address - Country:US
Mailing Address - Phone:708-371-0800
Mailing Address - Fax:708-371-0833
Practice Address - Street 1:271 E 161ST ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1400
Practice Address - Country:US
Practice Address - Phone:708-596-4442
Practice Address - Fax:708-596-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0035196315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities