Provider Demographics
NPI:1962411942
Name:BETHESDA CARE
Entity type:Organization
Organization Name:BETHESDA CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9199-670-5070
Mailing Address - Street 1:11312 US 15-501 NORTH
Mailing Address - Street 2:SUITE 400 CHATHAM CROSSING
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517
Mailing Address - Country:US
Mailing Address - Phone:919-967-0507
Mailing Address - Fax:919-967-1371
Practice Address - Street 1:11312 US 15-501 NORTH
Practice Address - Street 2:SUITE 400 CHATHAM CROSSING
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517
Practice Address - Country:US
Practice Address - Phone:919-967-0507
Practice Address - Fax:919-967-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1170251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600279Medicaid
NC34008537Medicaid