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NPI Code Detail

MEDICARE: BETHANY CHRISTIAN SERVICES

MEDICARE: BETHANY CHRISTIAN SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerM0518MS

General Provider Information

NPI Number : 1144656943
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETHANY CHRISTIAN SERVICES
Provider Business Mailing Address
First Line : 2624 SOUTHERLAND ST
Second Line :
City : JACKSON
State : MS
Zip : 39216-4825
Country : US
Telephone Number : 601-366-4282
Fax Number : 601-366-4287
Provider Business Practice Location Address
First Line : 2624 SOUTHERLAND ST
Second Line :
City : JACKSON
State : MS
Zip : 39216-4825
Country : US
Telephone Number : 601-366-4282
Fax Number : 601-366-4287
Authorized Official
Title or Position : BRANCH DIRECTOR
Name : KAREN STEWART
Credential : LMSW
Telephone Number : 601-366-4282
Provider Enumeration Date : 09/25/2013
Last Update Date : 09/25/2013

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Directions to “BETHANY CHRISTIAN SERVICES ” Practice Location

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