Healthcare Provider Details

I. General information

NPI: 1083702047
Provider Name (Legal Business Name): BETHANY HOMES AND METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 WAUKEGAN RD
MORTON GROVE IL
60053-2202
US

IV. Provider business mailing address

8425 WAUKEGAN RD
MORTON GROVE IL
60053-2202
US

V. Phone/Fax

Practice location:
  • Phone: 847-965-8100
  • Fax: 847-965-0114
Mailing address:
  • Phone: 847-965-8100
  • Fax: 847-965-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0015651
License Number StateIL

VIII. Authorized Official

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