Provider Demographics
NPI:1215298799
Name:BETHEL O & A, INCORPORATED
Entity type:Organization
Organization Name:BETHEL O & A, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.F.O / C.O.O
Authorized Official - Prefix:
Authorized Official - First Name:FEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABATAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-736-0770
Mailing Address - Street 1:114 E AIRPORT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3420
Mailing Address - Country:US
Mailing Address - Phone:626-736-0770
Mailing Address - Fax:909-890-4455
Practice Address - Street 1:114 E AIRPORT DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3420
Practice Address - Country:US
Practice Address - Phone:626-736-0770
Practice Address - Fax:909-890-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3352819343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)