NPIMap

Organization Active NPI

Bethshan Association

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Palos Heights, IL
National Provider Identifier
1164569281
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
0030528 Issued in IL
Legal business name
BETHSHAN ASSOCIATION
Practice address
12927 S Monitor Ave
Palos Heights, IL 60463-2434
Phone
(708) 371-0800
Fax
(708) 371-0833
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Steven J Goudzwaard
Title
Director of Finance
Phone
(708) 371-0800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 0030528 IL Primary

Addresses

Primary practice location

12927 S Monitor Ave
Palos Heights, IL 60463-2434

Mailing address

12927 S Monitor Ave
Palos Heights, IL 60463-2434
Phone (708) 371-0800

Other names 1

  • Bethshan Association II Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bethshan Association4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164569281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12927 S MONITOR AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604632434",
            "telephone_number": "708-371-0800",
            "fax_number": "708-371-0833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12927 S MONITOR AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604632434",
            "telephone_number": "708-371-0800",
            "fax_number": "708-371-0833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHSHAN ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOUDZWAARD",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "708-371-0800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "0030528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethshan Association II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palos Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.