Provider Demographics
NPI:1831651330
Name:BETHANY HOUSE RECOVERY HOUSE
Entity Type:Organization
Organization Name:BETHANY HOUSE RECOVERY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LABADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-343-1651
Mailing Address - Street 1:2615 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1654
Mailing Address - Country:US
Mailing Address - Phone:998-998-9998
Mailing Address - Fax:
Practice Address - Street 1:722 S ROSE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5216
Practice Address - Country:US
Practice Address - Phone:269-343-1651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALING CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility