Provider Demographics
NPI:1134206204
Name:BETHESDA INC
Entity type:Organization
Organization Name:BETHESDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:E
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED CLINICAL AD
Authorized Official - Phone:910-944-7700
Mailing Address - Street 1:204 NORTH PINE STREET
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2732
Mailing Address - Country:US
Mailing Address - Phone:910-944-7700
Mailing Address - Fax:910-944-7099
Practice Address - Street 1:204 NORTH PINE STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2732
Practice Address - Country:US
Practice Address - Phone:910-944-7700
Practice Address - Fax:910-944-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 063002324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility