Provider Demographics
NPI:1962156034
Name:BETHESDA FAMILY CARE HOME
Entity type:Organization
Organization Name:BETHESDA FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMNISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBERECHUKWU
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:IRECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-986-4611
Mailing Address - Street 1:984 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2896
Mailing Address - Country:US
Mailing Address - Phone:919-986-4611
Mailing Address - Fax:
Practice Address - Street 1:984 AVONDALE DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2896
Practice Address - Country:US
Practice Address - Phone:919-986-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home