Provider Demographics
NPI:1598107443
Name:BETHEL FAMILY
Entity Type:Organization
Organization Name:BETHEL FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EKUNDAYO
Authorized Official - Middle Name:OLADEHINDE
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:CDS/FMS
Authorized Official - Phone:469-831-4354
Mailing Address - Street 1:206 WATERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7475
Mailing Address - Country:US
Mailing Address - Phone:469-831-4354
Mailing Address - Fax:972-767-4076
Practice Address - Street 1:206 WATERWOOD DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7475
Practice Address - Country:US
Practice Address - Phone:469-831-4354
Practice Address - Fax:972-767-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251X00000XAgenciesSupports Brokerage