Provider Demographics
NPI:1457652646
Name:BETHANY HH OF LAKE JACKSON
Entity Type:Organization
Organization Name:BETHANY HH OF LAKE JACKSON
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:PO BOX 260875
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-0875
Mailing Address - Country:US
Mailing Address - Phone:972-248-2441
Mailing Address - Fax:972-248-0773
Practice Address - Street 1:207 THAT WAY ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5211
Practice Address - Country:US
Practice Address - Phone:979-297-1414
Practice Address - Fax:979-297-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health