Provider Demographics
NPI:1164612305
Name:BETHESDA HOME RESPIRATORY SERVICES INC
Entity Type:Organization
Organization Name:BETHESDA HOME RESPIRATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-774-1222
Mailing Address - Street 1:9320 INGALLS ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2822
Mailing Address - Country:US
Mailing Address - Phone:303-774-1222
Mailing Address - Fax:303-678-8287
Practice Address - Street 1:105 S SUNSET ST STE B
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6172
Practice Address - Country:US
Practice Address - Phone:303-657-1434
Practice Address - Fax:303-657-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26490630002332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53852885Medicaid
CO5585960001Medicare NSC