Provider Demographics
NPI:1124620794
Name:BETHEL ALF LLC
Entity type:Organization
Organization Name:BETHEL ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:YUSMEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FABREGAT MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-241-4086
Mailing Address - Street 1:15302 SW 142ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2877
Mailing Address - Country:US
Mailing Address - Phone:305-964-5103
Mailing Address - Fax:305-964-5103
Practice Address - Street 1:15302 SW 142ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2877
Practice Address - Country:US
Practice Address - Phone:305-964-5103
Practice Address - Fax:305-964-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility