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General NPI Number Information
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NPI Number | 1063764082
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Entity Type | Organization
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Legal Business Name | BEDFORD SPECIALIZED CARE, INC
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 34 BYRON ST
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City | BATTLE CREEK
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State | MI
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Zip | 49017-4860
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Country | US
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Telephone | 269-966-7459
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Fax | 269-968-1196
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Provider Business Mailing Address
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Address Line | 2775 W DICKMAN RD STE H1
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City | SPRINGFIELD
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State | MI
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Zip | 49037-4862
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Country | US
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Telephone | 269-753-6027
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Fax | 269-968-1196
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALAN MICHAEL DYER
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Credential |
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Telephone | 269-753-6027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS130095138
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License Number State | MI
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