Provider Demographics
NPI:1235474602
Name:BETHANY HH OF PRAIRIE AND LAKES, LLC
Entity Type:Organization
Organization Name:BETHANY HH OF PRAIRIE AND LAKES, LLC
Other - Org Name:BETHANY HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:18333 PRESTON RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5466
Mailing Address - Country:US
Mailing Address - Phone:972-248-2441
Mailing Address - Fax:972-248-2442
Practice Address - Street 1:1320 SANTA FE DR
Practice Address - Street 2:#200
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5875
Practice Address - Country:US
Practice Address - Phone:817-341-1436
Practice Address - Fax:817-341-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health