Provider Demographics
NPI:1447257449
Name:BETHANY OPERATING CO LLC
Entity type:Organization
Organization Name:BETHANY OPERATING CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OVERSIGHT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEWIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-588-8379
Mailing Address - Street 1:800 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2364
Mailing Address - Country:US
Mailing Address - Phone:315-339-3210
Mailing Address - Fax:315-339-6927
Practice Address - Street 1:800 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2364
Practice Address - Country:US
Practice Address - Phone:315-339-3210
Practice Address - Fax:315-339-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003201303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00312785Medicaid
NY003201303NOtherOPERATING CERTIFICATE
NY0594OtherPFI
NY0594OtherPFI