Healthcare Provider Details

I. General information

NPI: 1780842468
Provider Name (Legal Business Name): BETHANY CHRISTIAN SERVICES OF GREATER CHATTANOOGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S GERMANTOWN RD
CHATTANOOGA TN
37411-5025
US

IV. Provider business mailing address

400 S GERMANTOWN RD
CHATTANOOGA TN
37411-5025
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-7360
  • Fax: 423-622-9085
Mailing address:
  • Phone: 423-622-7360
  • Fax: 423-622-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberSO/10191A
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSO/10191A
License Number StateTN

VIII. Authorized Official

Name: MRS. MARGARET H LOWE
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 423-622-7360