MEDICARE: BETHANNA

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
1	251S00000X	Community/Behavioral Health Agency	100910	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962627851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANNA

Provider Business Mailing Address
First Line	:	1030 2ND STREET PIKE
Second Line	:
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3955
Country	:	US
Telephone Number	:	215-355-6500
Fax Number	:	215-355-8617

Provider Business Practice Location Address
First Line	:	1212 WOOD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-1113
Country	:	US
Telephone Number	:	215-568-2435
Fax Number	:	215-564-4740

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. RONALD L FRITCH
Credential	:
Telephone Number	:	215-355-6500

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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Directions to “BETHANNA ” Practice Location

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