Healthcare Provider Details

I. General information

NPI: 1245242676
Provider Name (Legal Business Name): BETHANY CARE CENTER L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42235 COUNTY ROAD 390
BLOOMINGDALE MI
49026-8753
US

IV. Provider business mailing address

3075 ORCHARD VISTA DR SE SUITE 100
GRAND RAPIDS MI
49546-7069
US

V. Phone/Fax

Practice location:
  • Phone: 269-521-3383
  • Fax: 269-521-3370
Mailing address:
  • Phone: 616-957-3957
  • Fax: 616-957-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number804010
License Number StateMI

VIII. Authorized Official

Name: MR. J LINDSEY DOOD
Title or Position: EXECUTIVE VICE PRESIDENT / CFO
Credential:
Phone: 616-975-5287