Provider Demographics
NPI:1558710921
Name:BETHEL HOMECARE INC
Entity Type:Organization
Organization Name:BETHEL HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANIEMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:UDOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-451-5531
Mailing Address - Street 1:5500 EXECUTIVE CENTER DR STE 214
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8864
Mailing Address - Country:US
Mailing Address - Phone:704-451-5531
Mailing Address - Fax:866-523-4376
Practice Address - Street 1:5500 EXECUTIVE CENTER DR STE 214
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8864
Practice Address - Country:US
Practice Address - Phone:704-451-5531
Practice Address - Fax:866-523-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3329251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care