Provider Demographics
NPI:1598156846
Name:BETHLEHEM HOME HEALTH CDS, INC
Entity Type:Organization
Organization Name:BETHLEHEM HOME HEALTH CDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MABION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-474-6371
Mailing Address - Street 1:2726 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-1224
Mailing Address - Country:US
Mailing Address - Phone:816-474-6371
Mailing Address - Fax:816-842-1751
Practice Address - Street 1:2726 FOREST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-1224
Practice Address - Country:US
Practice Address - Phone:816-474-6371
Practice Address - Fax:816-842-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1085922432251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0014773Medicaid