Provider Demographics
NPI:1871583435
Name:BETHANY MHS HEALTH CARE CENTER
Entity type:Organization
Organization Name:BETHANY MHS HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:NFA
Authorized Official - Phone:337-234-2459
Mailing Address - Street 1:406 SAINT JULIEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4622
Mailing Address - Country:US
Mailing Address - Phone:337-234-2459
Mailing Address - Fax:
Practice Address - Street 1:406 SAINT JULIEN AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4622
Practice Address - Country:US
Practice Address - Phone:337-234-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS OF THE MOST HOLY SACRAMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1520951Medicaid
LA1520951Medicaid