MEDICARE: BETHANY MHS HEALTH CARE CENTER

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	313M00000X	Nursing Facility/Intermediate Care Facility	200	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871583435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY MHS HEALTH CARE CENTER

Provider Business Mailing Address
First Line	:	406 SAINT JULIEN AVE
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4622
Country	:	US
Telephone Number	:	337-234-2459
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 SAINT JULIEN AVE
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4622
Country	:	US
Telephone Number	:	337-234-2459
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DANNY E JARVIS
Credential	:	NFA
Telephone Number	:	337-234-2459

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	04/15/2008

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