Provider Demographics
NPI:1285202994
Name:BETHANY HOME HEALTH LLC
Entity Type:Organization
Organization Name:BETHANY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUGUESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-332-4475
Mailing Address - Street 1:PO BOX 13700
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-1700
Mailing Address - Country:US
Mailing Address - Phone:425-332-4475
Mailing Address - Fax:425-332-4475
Practice Address - Street 1:1902 120TH PL SE STE 203
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6292
Practice Address - Country:US
Practice Address - Phone:425-338-3000
Practice Address - Fax:425-740-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2224744Medicaid
WAIHS.FS.60966822OtherWA STATE DEPT OF HEALTH