Provider Demographics
NPI:1780842468
Name:BETHANY CHRISTIAN SERVICES OF GREATER CHATTANOOGA
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES OF GREATER CHATTANOOGA
Other - Org Name:BETHANY CHRISTIAN SERVICES OF TENNESSEE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:423-622-7360
Mailing Address - Street 1:400 S GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5025
Mailing Address - Country:US
Mailing Address - Phone:423-622-7360
Mailing Address - Fax:423-622-9085
Practice Address - Street 1:400 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5025
Practice Address - Country:US
Practice Address - Phone:423-622-7360
Practice Address - Fax:423-622-9085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY CHRISTIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSO/10191A251S00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health