Provider Demographics
NPI:1790055788
Name:BETHANY CHRISTIAN SERVICES USA, LLC
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MICHIGAN DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEVOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-254-7717
Mailing Address - Street 1:1050 36TH ST SE
Mailing Address - Street 2:400
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5580
Mailing Address - Country:US
Mailing Address - Phone:616-965-8096
Mailing Address - Fax:616-254-7750
Practice Address - Street 1:1050 36TH ST SE
Practice Address - Street 2:400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5580
Practice Address - Country:US
Practice Address - Phone:616-965-8096
Practice Address - Fax:616-254-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency