Provider Demographics
NPI:1003969130
Name:BETHESDA HOME HEALTH CARE, PLLC
Entity Type:Organization
Organization Name:BETHESDA HOME HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DON
Authorized Official - Last Name:HARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-216-1818
Mailing Address - Street 1:717 CARVER ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-5009
Mailing Address - Country:US
Mailing Address - Phone:972-216-1818
Mailing Address - Fax:972-216-1919
Practice Address - Street 1:8204 ELMBROOK DR
Practice Address - Street 2:SUITE 135
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4067
Practice Address - Country:US
Practice Address - Phone:214-879-0803
Practice Address - Fax:214-879-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009188251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1747131Medicaid
TX67-3165Medicare ID - Type Unspecified