Provider Demographics
NPI:1790071454
Name:BETHEL O & A, INCORPORATED
Entity Type:Organization
Organization Name:BETHEL O & A, INCORPORATED
Other - Org Name:DIVINE RECOVERY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABATAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-225-4762
Mailing Address - Street 1:285 S GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2908
Mailing Address - Country:US
Mailing Address - Phone:714-225-4762
Mailing Address - Fax:714-930-9435
Practice Address - Street 1:285 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2908
Practice Address - Country:US
Practice Address - Phone:714-225-4762
Practice Address - Fax:714-930-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QH0100X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service