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General NPI Number Information
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NPI Number | 1124586060
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Entity Type | Organization
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Legal Business Name | BETHANY CHRISTIAN SERVICES OF NC
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 1110 NAVAHO DR STE 109
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City | RALEIGH
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State | NC
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Zip | 27609-7352
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Country | US
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Telephone | 919-510-9511
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Fax | 919-510-9512
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Provider Business Mailing Address
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Address Line | 1110 NAVAHO DR STE 109
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City | RALEIGH
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State | NC
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Zip | 27609-7352
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Country | US
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Telephone | 919-510-9511
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Fax | 919-510-9512
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Authorized Official
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Title or Position | DIRECTOR
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Name | TERRI BOWLES
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Credential | MS, NCC
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Telephone | 704-541-1833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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