Provider Demographics
NPI:1578516878
Name:BETHESDA HEALTHCARE AGENCY, INC
Entity Type:Organization
Organization Name:BETHESDA HEALTHCARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MITCHEL
Authorized Official - Last Name:NASIBOYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-849-8502
Mailing Address - Street 1:5232 MIRROR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76117-1325
Mailing Address - Country:US
Mailing Address - Phone:817-849-8502
Mailing Address - Fax:817-788-5774
Practice Address - Street 1:5232 MIRROR LAKE DR
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-1325
Practice Address - Country:US
Practice Address - Phone:817-849-8502
Practice Address - Fax:817-788-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010613251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health