Provider Demographics
NPI:1699025437
Name:BETHANY HOME HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:BETHANY HOME HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUEELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TADOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-503-5225
Mailing Address - Street 1:8902 OTIS AVE
Mailing Address - Street 2:STE 201B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-1077
Mailing Address - Country:US
Mailing Address - Phone:877-503-5225
Mailing Address - Fax:
Practice Address - Street 1:8902 OTIS AVE
Practice Address - Street 2:STE 201B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1077
Practice Address - Country:US
Practice Address - Phone:877-503-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health