Provider Demographics
NPI:1831440783
Name:BETHEL RESIDENTIAL HOMES
Entity type:Organization
Organization Name:BETHEL RESIDENTIAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LENA
Authorized Official - Middle Name:JEANNETTE
Authorized Official - Last Name:THOMAS-OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:804-617-3159
Mailing Address - Street 1:15601 CHESDIN LANDING TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-3242
Mailing Address - Country:US
Mailing Address - Phone:804-617-3159
Mailing Address - Fax:804-504-0057
Practice Address - Street 1:15601 CHESDIN LANDING TER
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-3242
Practice Address - Country:US
Practice Address - Phone:804-617-3159
Practice Address - Fax:804-504-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12358320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities