Provider Demographics
NPI:1740422567
Name:BETHSAIDA HOME HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:BETHSAIDA HOME HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:
Authorized Official - Last Name:EKPENYONG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:214-869-8824
Mailing Address - Street 1:3727 DILIDO RD
Mailing Address - Street 2:SUITE 136
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5531
Mailing Address - Country:US
Mailing Address - Phone:214-445-0742
Mailing Address - Fax:214-445-6307
Practice Address - Street 1:3727 DILIDO RD
Practice Address - Street 2:SUITE 136
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-5531
Practice Address - Country:US
Practice Address - Phone:214-445-0742
Practice Address - Fax:214-445-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2074577Medicaid
TX001018474OtherDADS