Healthcare Provider Details

I. General information

NPI: 1669708210
Provider Name (Legal Business Name): BETHANY HOMES AND METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 N SHERIDAN RD
CHICAGO IL
60640-3117
US

IV. Provider business mailing address

5025 N PAULINA ST
CHICAGO IL
60640-2772
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-9040
  • Fax: 773-989-1377
Mailing address:
  • Phone: 773-989-1465
  • Fax: 773-989-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD MARSHALL REISLER
Title or Position: CONTROLLER
Credential:
Phone: 773-989-1465