Provider Demographics
NPI:1063764082
Name:BEDFORD SPECIALIZED CARE, INC
Entity type:Organization
Organization Name:BEDFORD SPECIALIZED CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-753-6027
Mailing Address - Street 1:2775 W DICKMAN RD
Mailing Address - Street 2:STE H1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-4862
Mailing Address - Country:US
Mailing Address - Phone:269-753-6027
Mailing Address - Fax:269-968-1196
Practice Address - Street 1:34 BYRON ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-4860
Practice Address - Country:US
Practice Address - Phone:269-966-7459
Practice Address - Fax:269-968-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS130095138320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness