Healthcare Provider Details

I. General information

NPI: 1447257449
Provider Name (Legal Business Name): BETHANY OPERATING CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CHESTNUT ST
ROME NY
13440-2364
US

IV. Provider business mailing address

800 W CHESTNUT ST
ROME NY
13440-2364
US

V. Phone/Fax

Practice location:
  • Phone: 315-339-3210
  • Fax: 315-339-6927
Mailing address:
  • Phone: 315-339-3210
  • Fax: 315-339-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number003201303N
License Number StateNY

VIII. Authorized Official

Name: MR. JONATHAN GEWIRTZ
Title or Position: FISCAL OVERSIGHT
Credential:
Phone: 914-588-8379