Bethel Residential Home LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

1235 Issued in VA

Legal business name

BETHEL RESIDENTIAL HOME LLC

Practice address

14014 Lippingham Cir
Chester, VA 23831-6526

Phone

(804) 318-1349

Fax

(804) 318-1352

NPI assigned

Sep 19, 2009

Last updated

Sep 19, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Lerlena Jeanette Oliver, M-DIV

Title

Director

Phone

(804) 318-1349

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1253318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253318400000",
    "number": "1336473610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4625 TOOLEY DR",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238316636",
            "telephone_number": "804-318-9298",
            "fax_number": "804-318-1352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14014 LIPPINGHAM CIR",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238316526",
            "telephone_number": "804-318-1349",
            "fax_number": "804-318-1352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL RESIDENTIAL HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-19",
        "last_updated": "2009-09-19",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "LERLENA",
        "authorized_official_middle_name": "JEANETTE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "804-318-1349",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M-DIV"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "VA",
            "license": "1235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Chester, VA
• Providers in Chester, VA by specialty
• Developmentally Disabled Services Day Training Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2009; 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.