Provider Demographics
NPI:1457926610
Name:BETHEL BEHAVIORAL CARE LLC
Entity Type:Organization
Organization Name:BETHEL BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:SERWA
Authorized Official - Last Name:BONSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-804-0145
Mailing Address - Street 1:44304 W VINEYARD ST
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-9053
Mailing Address - Country:US
Mailing Address - Phone:614-806-0145
Mailing Address - Fax:
Practice Address - Street 1:44304 W VINEYARD ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-9053
Practice Address - Country:US
Practice Address - Phone:614-806-0145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances