Provider Demographics
NPI:1003439472
Name:BETHEL SKILLED HOME CARE LLC
Entity Type:Organization
Organization Name:BETHEL SKILLED HOME CARE LLC
Other - Org Name:BETHEL SKILLED HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:NWUBA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:571-523-5479
Mailing Address - Street 1:6024 IRONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-7725
Mailing Address - Country:US
Mailing Address - Phone:571-523-5479
Mailing Address - Fax:804-374-8889
Practice Address - Street 1:3611 BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1344
Practice Address - Country:US
Practice Address - Phone:571-523-5479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health