Provider Demographics
NPI:1013891928
Name:BETHEL SUPPORT LLC
Entity type:Organization
Organization Name:BETHEL SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOO
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETHEL
Authorized Official - Middle Name:FOMONYUY
Authorized Official - Last Name:KEWONG
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:513-250-8785
Mailing Address - Street 1:4175 CONTINENTAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2392
Mailing Address - Country:US
Mailing Address - Phone:513-250-8785
Mailing Address - Fax:
Practice Address - Street 1:375 GLENSPRINGS DR STE 400
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2392
Practice Address - Country:US
Practice Address - Phone:513-250-8785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty