NPIMap

Organization Active NPI

Bethany Christian Services Inc.

  • Community/Behavioral Health Agency
  • Grand Rapids, MI
National Provider Identifier
1528104643
Registry record updated Oct 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
410218 Issued in MI
Legal business name
BETHANY CHRISTIAN SERVICES INC.
Practice address
901 Eastern Ave NE
Grand Rapids, MI 49503-1201
Phone
(616) 224-7617
Fax
(616) 224-7593
NPI assigned
Jan 29, 2007
Last updated
Oct 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2013

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

Authorized official

Name
George John Tyndall, MSWNPI 1770649600
Title
Branch Director
Phone
(616) 224-7617

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X CB410200976 MI
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 635720364 MI
Community/Behavioral Health Agency 251S00000X 410218 MI Primary

Addresses

Primary practice location

901 Eastern Ave NE
Grand Rapids, MI 49503-1201

Mailing address

901 Eastern Ave NE
P.O. Box 294
Grand Rapids, MI 49503-1201
Phone (616) 224-7617

Other names 1

  • Grand Rapids Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040913000022 MI Part B Supplier - Clinic/Group Practice 2567439342 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Haven, MI; Grand Rapdis, MI; Holland, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bethany Christian Services Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

901 Eastern Ave NE
Grand Rapids, MI 49503
Phone (616) 224-7617

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382572800000",
    "number": "1528104643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 EASTERN AVE NE",
            "address_2": "P.O. BOX 294",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031201",
            "telephone_number": "616-224-7617",
            "fax_number": "616-224-7593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 EASTERN AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031201",
            "telephone_number": "616-224-7617",
            "fax_number": "616-224-7593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY CHRISTIAN SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2013-10-24",
        "status": "A",
        "authorized_official_last_name": "TYNDALL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "BRANCH DIRECTOR",
        "authorized_official_telephone_number": "616-224-7617",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MI",
            "license": "CB410200976",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MI",
            "license": "635720364",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "410218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Rapids",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.