Provider Demographics
NPI:1306613609
Name:BETHLEHEM LLC
Entity type:Organization
Organization Name:BETHLEHEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIGIST
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWOYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:425-365-8290
Mailing Address - Street 1:3347 SE 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1711
Mailing Address - Country:US
Mailing Address - Phone:425-365-8290
Mailing Address - Fax:
Practice Address - Street 1:3347 SE 115TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1711
Practice Address - Country:US
Practice Address - Phone:425-365-8290
Practice Address - Fax:503-265-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty