Provider Demographics
NPI:1780124420
Name:BETHANY CARE STAT INC.
Entity type:Organization
Organization Name:BETHANY CARE STAT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMOTHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-347-1614
Mailing Address - Street 1:11 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3622
Mailing Address - Country:US
Mailing Address - Phone:718-347-1614
Mailing Address - Fax:
Practice Address - Street 1:25610 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1253
Practice Address - Country:US
Practice Address - Phone:718-347-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health