Provider Demographics
NPI:1720519606
Name:BETHESDA ALCOHOL AND DRUG TREATMENT PROGRAM
Entity Type:Organization
Organization Name:BETHESDA ALCOHOL AND DRUG TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:513-569-6299
Mailing Address - Street 1:619 OAK ST
Mailing Address - Street 2:4 WEST
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1613
Mailing Address - Country:US
Mailing Address - Phone:513-569-6116
Mailing Address - Fax:
Practice Address - Street 1:619 OAK ST
Practice Address - Street 2:4 WEST
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1613
Practice Address - Country:US
Practice Address - Phone:513-569-6116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHESDA HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH360179Medicare UPIN