Provider Demographics
NPI:1184783540
Name:BETHANY HOME HEALTH OF LUFKIN LP
Entity type:Organization
Organization Name:BETHANY HOME HEALTH OF LUFKIN LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-248-2441
Mailing Address - Street 1:5000 LEGACY DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3100
Mailing Address - Country:US
Mailing Address - Phone:972-248-2441
Mailing Address - Fax:972-248-0773
Practice Address - Street 1:2516 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-6047
Practice Address - Country:US
Practice Address - Phone:979-244-5265
Practice Address - Fax:979-244-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1716888-01Medicaid
TX1716888-01Medicaid