Provider Demographics
NPI:1174228639
Name:BETHANY FOR CHILDREN & FAMILIES
Entity type:Organization
Organization Name:BETHANY FOR CHILDREN & FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING CREDENTIALING COORDINAT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-327-0203
Mailing Address - Street 1:1701 RIVER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1384
Mailing Address - Country:US
Mailing Address - Phone:309-797-7700
Mailing Address - Fax:563-243-9567
Practice Address - Street 1:1701 RIVER DR STE 200
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1384
Practice Address - Country:US
Practice Address - Phone:309-797-7700
Practice Address - Fax:309-797-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1B00-IPI-014Medicaid