MEDICARE: GREATER BETHEL TABERNACLE, INC

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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1275089278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER BETHEL TABERNACLE, INC

Provider Business Mailing Address
First Line	:	1515 SECTION RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 SECTION RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3306
Country	:	US
Telephone Number	:	513-924-9777
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHEILA K BENTON
Credential	:
Telephone Number	:	513-924-9777

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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