Provider Demographics
NPI:1306021340
Name:BETHANY HOME HEALTH CARE
Entity Type:Organization
Organization Name:BETHANY HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:OTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, C
Authorized Official - Phone:712-310-4455
Mailing Address - Street 1:11 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0223
Mailing Address - Country:US
Mailing Address - Phone:712-310-4455
Mailing Address - Fax:712-329-4058
Practice Address - Street 1:11 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0223
Practice Address - Country:US
Practice Address - Phone:712-310-4455
Practice Address - Fax:712-329-4058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY LUTHERAN HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089615251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health