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General NPI Number Information
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NPI Number | 1578699500
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Entity Type | Organization
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Legal Business Name | BETHANY RETIREMENT HOME, INC.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 3005 WATKINS RD
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City | HORSEHEADS
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State | NY
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Zip | 14845-1800
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Country | US
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Telephone | 607-739-8711
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Fax | 607-796-2566
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Provider Business Mailing Address
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Address Line | 3005 WATKINS RD
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City | HORSEHEADS
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State | NY
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Zip | 14845-1800
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Country | US
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Telephone | 607-739-8711
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Fax | 607-796-2566
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | MR. MICHAEL S. KISER
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Credential |
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Telephone | 607-378-6574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 9305L001
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License Number State | NY
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