Provider Demographics
NPI:1912575440
Name:THE HOUSE OF BETHESDA
Entity Type:Organization
Organization Name:THE HOUSE OF BETHESDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-675-1444
Mailing Address - Street 1:14614 FIRMONA A VENUE
Mailing Address - Street 2:PO BOX 5373 INGLEWOOD, CA 90305
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1338
Mailing Address - Country:US
Mailing Address - Phone:310-675-1444
Mailing Address - Fax:310-675-1333
Practice Address - Street 1:14614 FIRMONA AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1339
Practice Address - Country:US
Practice Address - Phone:310-675-1444
Practice Address - Fax:310-675-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA912575440Medicaid