Organization
BETHANNA
Active
Organization
BETHANNA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MICHAEL CHASE (CIO)
(215) 355-6500
Entity
Organization
Contact information
Practice address
2500 WHARTON ST, PHILADELPHIA, PA 19146-3942
(215) 355-6500
Mailing address
1030 SECOND STREET PIKE, SOUTHAMPTON, PA 18966-3955
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
100910
—
251S00000X
Community/Behavioral Health Agency
143290
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100751341
—
PA
Enumeration date
11/17/2017
Last updated
11/17/2017
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