Provider Demographics
NPI:1205515558
Name:MCBETH, LORETTA LEE
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:LEE
Last Name:MCBETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S DANA AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2913
Mailing Address - Country:US
Mailing Address - Phone:419-905-4922
Mailing Address - Fax:
Practice Address - Street 1:17179 STATE ROUTE 190
Practice Address - Street 2:
Practice Address - City:FORT JENNINGS
Practice Address - State:OH
Practice Address - Zip Code:45844-9103
Practice Address - Country:US
Practice Address - Phone:419-286-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRX621735253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care