Provider Demographics
NPI:1699485938
Name:BETHESDA HOME HEALTHCARE PROVIDER LLC
Entity type:Organization
Organization Name:BETHESDA HOME HEALTHCARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENESE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-330-2202
Mailing Address - Street 1:4045 S BUFFALO DR # A101-425
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7479
Mailing Address - Country:US
Mailing Address - Phone:330-330-2202
Mailing Address - Fax:330-951-1801
Practice Address - Street 1:5815 MARKET ST STE 6
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2915
Practice Address - Country:US
Practice Address - Phone:330-330-2202
Practice Address - Fax:330-953-1801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHESDA HOME HEALTHCARE PROVIDER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-28
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health