Provider Demographics
NPI:1174527758
Name:BETHALTO CARE CENTER, INC.
Entity type:Organization
Organization Name:BETHALTO CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-377-2144
Mailing Address - Street 1:815 S PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-1847
Mailing Address - Country:US
Mailing Address - Phone:618-377-2144
Mailing Address - Fax:618-377-3349
Practice Address - Street 1:815 S PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-1847
Practice Address - Country:US
Practice Address - Phone:618-377-2144
Practice Address - Fax:618-377-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0021584313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility