Provider Demographics
NPI:1649753070
Name:BETHSON HOMEHEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:BETHSON HOMEHEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BONGHOR
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-704-6196
Mailing Address - Street 1:3108 PS BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4258
Mailing Address - Country:US
Mailing Address - Phone:414-704-6196
Mailing Address - Fax:
Practice Address - Street 1:3108 PS BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4258
Practice Address - Country:US
Practice Address - Phone:571-552-3509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health