Healthcare Provider Details

I. General information

NPI: 1073607735
Provider Name (Legal Business Name): THE BETHANY HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E. VERMONT AVE.
SOUTHERN PINES NC
28387
US

IV. Provider business mailing address

240 E. VERMONT AVE.
SOUTHERN PINES NC
28387
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-0779
  • Fax: 910-692-7834
Mailing address:
  • Phone: 910-692-0779
  • Fax: 910-692-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-063-005
License Number StateNC

VIII. Authorized Official

Name: CYNTHIA CURTIS
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 910-692-0779