Bethany Residential Care, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

BETHANY RESIDENTIAL CARE, LLC

Practice address

5632 Chimney Cir
Kettering, OH 45440-4259

Phone

(207) 518-0783

NPI assigned

Jan 28, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Albert K. Mukunda

Title

Owner

Phone

(207) 518-0783

Specialties & licenses 1

Addresses

Other names 1

• Bethany Residential Care, LLC Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1043963291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5632 CHIMNEY CIR",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454404259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5632 CHIMNEY CIR",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454404259",
            "telephone_number": "207-518-0783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY RESIDENTIAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "MUKUNDA",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-518-0783"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Devices",
            "affiliation": "N",
            "endpointDescription": "Electronic devices",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5632 Chimney Cir",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454404259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bethany Residential Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ruth Anne Bendel, CRNA
• Joshua Taylor Bernal, DO
• Amy Elisha Bernard, ATC, NASM-PES
• Jack Mark Bernstein, M.D.
• Lidia Maria Berrone, NP
• Prashanth Bhat, MD
• John K Bidwell, MD
• Mark Bidwell, M.D.
• Jonathan Seth Bingham, D.O.
• Taylor Birch, PA

• All providers in Kettering, OH
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.