Provider Demographics
NPI:1184853145
Name:BETHANY HH OF WACO LLC
Entity Type:Organization
Organization Name:BETHANY HH OF WACO LLC
Other - Org Name:BETHANY HOME HEALTH OF WACO LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-248-2441
Mailing Address - Street 1:5000 LEGACY DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3100
Mailing Address - Country:US
Mailing Address - Phone:972-248-2441
Mailing Address - Fax:972-248-0773
Practice Address - Street 1:329 W HWY 6
Practice Address - Street 2:SUITE B
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5590
Practice Address - Country:US
Practice Address - Phone:254-741-6451
Practice Address - Fax:254-741-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2193088-01Medicaid
TX747461Medicare Oscar/Certification