Provider Demographics
NPI:1639643356
Name:BETHEL GROUP LLC
Entity Type:Organization
Organization Name:BETHEL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-933-9797
Mailing Address - Street 1:67 MILLBROOK ST STE 420
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2845
Mailing Address - Country:US
Mailing Address - Phone:918-933-9797
Mailing Address - Fax:
Practice Address - Street 1:67 MILLBROOK ST STE 420
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2845
Practice Address - Country:US
Practice Address - Phone:918-933-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health