Provider Demographics
NPI:1902783814
Name:BETHEL HOME CARE LLC
Entity type:Organization
Organization Name:BETHEL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-612-0737
Mailing Address - Street 1:9230 N 82ND LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-4828
Mailing Address - Country:US
Mailing Address - Phone:602-612-0737
Mailing Address - Fax:
Practice Address - Street 1:23 ORMOND ST APT 11
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-6181
Practice Address - Country:US
Practice Address - Phone:603-497-1238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities