Provider Demographics
NPI:1205957800
Name:BETHANY COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:BETHANY COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-374-2160
Mailing Address - Street 1:10 PHOENIX ROW
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5734
Mailing Address - Country:US
Mailing Address - Phone:978-374-2160
Mailing Address - Fax:978-374-2163
Practice Address - Street 1:100 WATER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830
Practice Address - Country:US
Practice Address - Phone:978-374-2168
Practice Address - Fax:978-374-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1901966Medicaid