Provider Demographics
NPI:1760728182
Name:BETHANY CHRISTIAN SERVICES
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MADALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-221-0734
Mailing Address - Street 1:3000 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-6331
Mailing Address - Country:US
Mailing Address - Phone:720-256-2654
Mailing Address - Fax:
Practice Address - Street 1:3000 S RACE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-6331
Practice Address - Country:US
Practice Address - Phone:720-256-2654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY CHRISTIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO455141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty