Provider Demographics
NPI:1568968980
Name:BESS, BETTY R (SOLE PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:R
Last Name:BESS
Suffix:
Gender:F
Credentials:SOLE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 FOXLAIR TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2730
Mailing Address - Country:US
Mailing Address - Phone:216-299-9280
Mailing Address - Fax:
Practice Address - Street 1:4944 FOXLAIR TRL
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2730
Practice Address - Country:US
Practice Address - Phone:216-299-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255760Medicaid