Provider Demographics
NPI:1740382803
Name:BETHEL HEALTH AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:BETHEL HEALTH AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-830-4180
Mailing Address - Street 1:13 PARK LAWN DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1043
Mailing Address - Country:US
Mailing Address - Phone:203-830-4180
Mailing Address - Fax:203-830-4185
Practice Address - Street 1:13 PARK LAWN DR
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1043
Practice Address - Country:US
Practice Address - Phone:203-830-4180
Practice Address - Fax:203-830-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2218C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2218COtherDEPT OF HEALTH LICENSE
CT000021387Medicaid
CT000021387Medicaid