Provider Demographics
NPI:1952844110
Name:BETHANY CHRISTIAN SERVICES OF. SC.
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES OF. SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUTMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-224-7429
Mailing Address - Street 1:PO BOX 14400
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587
Mailing Address - Country:US
Mailing Address - Phone:843-353-6600
Mailing Address - Fax:
Practice Address - Street 1:9403 HWY 709
Practice Address - Street 2:SUITE D
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588
Practice Address - Country:US
Practice Address - Phone:843-353-6600
Practice Address - Fax:843-839-4555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY CHRISTIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty