Provider Demographics
NPI:1285405605
Name:BETHESDA HEALTH AND REJUVENATION CENTER LLC
Entity type:Organization
Organization Name:BETHESDA HEALTH AND REJUVENATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:KYRIA
Authorized Official - Last Name:AIME CELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-426-4797
Mailing Address - Street 1:8010 SUNPORT DR STE 116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8010 SUNPORT DR STE 116
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7897
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty