Provider Demographics
NPI:1760928162
Name:BETHEL HOME HEALTH CARE
Entity Type:Organization
Organization Name:BETHEL HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:240-766-6070
Mailing Address - Street 1:9607 MCWHORTER FARM CT
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-3302
Mailing Address - Country:US
Mailing Address - Phone:240-766-6070
Mailing Address - Fax:301-414-5468
Practice Address - Street 1:9607 MCWHORTER FARM CT
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-3302
Practice Address - Country:US
Practice Address - Phone:240-766-6070
Practice Address - Fax:301-414-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5423597500Medicaid