Provider Demographics
NPI:1811195951
Name:BETHEL COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:BETHEL COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:BETHEL ADULT DAY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-484-8727
Mailing Address - Street 1:1065 PROGRESS ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-1827
Mailing Address - Country:US
Mailing Address - Phone:910-484-8727
Mailing Address - Fax:910-486-7981
Practice Address - Street 1:1065 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-1827
Practice Address - Country:US
Practice Address - Phone:910-484-8727
Practice Address - Fax:910-486-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCERTIFICATE261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409003Medicaid