Provider Demographics
NPI:1306105358
Name:BETHANY HOMES AND METHODIST HOSPITAL
Entity type:Organization
Organization Name:BETHANY HOMES AND METHODIST HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-271-9040
Mailing Address - Street 1:2601 CHESTNUT AVE
Mailing Address - Street 2:SUITE 3310
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8314
Mailing Address - Country:US
Mailing Address - Phone:847-904-5134
Mailing Address - Fax:847-904-5137
Practice Address - Street 1:2601 CHESTNUT AVE
Practice Address - Street 2:SUITE 3310
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8314
Practice Address - Country:US
Practice Address - Phone:847-904-5134
Practice Address - Fax:847-904-5137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY HOMES AND METHODIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-11
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011589251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health