Provider Demographics
NPI: | 1174852610 |
---|---|
Name: | BETHEL HEALTH CARE SERVICES,LLC |
Entity Type: | Organization |
Organization Name: | BETHEL HEALTH CARE SERVICES,LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROGAM DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | OLUSEYE |
Authorized Official - Middle Name: | O |
Authorized Official - Last Name: | ADEKUNLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 832-882-4536 |
Mailing Address - Street 1: | 9396 RICHMOND AVE |
Mailing Address - Street 2: | SUITE 109 |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77063-3950 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 832-882-4536 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 9396 RICHMOND AVE |
Practice Address - Street 2: | SUITE 109 |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77063-3950 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-882-4536 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-12-11 |
Last Update Date: | 2009-12-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |