Provider Demographics
NPI:1144539297
Name:BETHEL HOME CARE SERVICES
Entity type:Organization
Organization Name:BETHEL HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUYEMISI
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:972-274-9010
Mailing Address - Street 1:104 LION ST,SUITE B
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5071
Mailing Address - Country:US
Mailing Address - Phone:972-274-9010
Mailing Address - Fax:972-274-9086
Practice Address - Street 1:104 LION ST STE B
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5071
Practice Address - Country:US
Practice Address - Phone:972-274-9010
Practice Address - Fax:972-274-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health