Provider Demographics
NPI:1679969075
Name:FIRST BETHEL PLACE LLC
Entity Type:Organization
Organization Name:FIRST BETHEL PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-213-6728
Mailing Address - Street 1:406 W FIFTH ST APT 16
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-4171
Mailing Address - Country:US
Mailing Address - Phone:301-213-6728
Mailing Address - Fax:
Practice Address - Street 1:406 W. FIFTH ST APT16
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833
Practice Address - Country:US
Practice Address - Phone:301-213-6728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services