Basic Information
| Provider Information | |||||||||
| NPI: | 1720519606 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETHESDA ALCOHOL AND DRUG TREATMENT PROGRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 OAK ST | ||||||||
| Address2: | 4 WEST | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696116 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 OAK ST | ||||||||
| Address2: | 4 WEST | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | FREY | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5135696299 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BETHESDA HOSPITAL, INC. | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.