Provider Demographics
NPI:1336030444
Name:BETHSAIDA
Entity type:Organization
Organization Name:BETHSAIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MISRAK
Authorized Official - Middle Name:GEBRIE
Authorized Official - Last Name:HEREGO
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:206-349-6892
Mailing Address - Street 1:32223 25TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2508
Mailing Address - Country:US
Mailing Address - Phone:206-349-6892
Mailing Address - Fax:
Practice Address - Street 1:32223 25TH AVE SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2508
Practice Address - Country:US
Practice Address - Phone:206-349-6892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care