Provider Demographics
NPI:1962155739
Name:BETHEL HILLS INTEGRATED HEALTHCARE
Entity type:Organization
Organization Name:BETHEL HILLS INTEGRATED HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMOLAFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-542-3181
Mailing Address - Street 1:13838 S 46TH PL STE 340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7805
Mailing Address - Country:US
Mailing Address - Phone:480-597-7903
Mailing Address - Fax:480-597-7904
Practice Address - Street 1:13838 S 46TH PL STE 340
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7805
Practice Address - Country:US
Practice Address - Phone:480-597-7903
Practice Address - Fax:480-597-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251K00000XAgenciesPublic Health or Welfare
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No252Y00000XAgenciesEarly Intervention Provider Agency