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NPI Code Detail

MEDICARE: BETHEL SKILLED HOME CARE LLC

MEDICARE: BETHEL SKILLED HOME CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1003439472
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETHEL SKILLED HOME CARE LLC
Provider Business Mailing Address
First Line : 6024 IRONSTONE DR
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23234-7725
Country : US
Telephone Number : 571-523-5479
Fax Number : 804-374-8889
Provider Business Practice Location Address
First Line : 3611 BOULEVARD
Second Line :
City : COLONIAL HEIGHTS
State : VA
Zip : 23834-1344
Country : US
Telephone Number : 571-523-5479
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR/OWNER
Name : DR. JESSY NWUBA
Credential : REGISTERED NURSE
Telephone Number : 571-523-5479
Provider Enumeration Date : 05/20/2020
Last Update Date : 12/18/2021

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Directions to “BETHEL SKILLED HOME CARE LLC ” Practice Location

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