Healthcare Provider Details

I. General information

NPI: 1780546713
Provider Name (Legal Business Name): BETHESDA LIFE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2025
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WALL ST
GADSDEN AL
35904-1940
US

IV. Provider business mailing address

201 WALL ST
GADSDEN AL
35904-1940
US

V. Phone/Fax

Practice location:
  • Phone: 917-684-4470
  • Fax:
Mailing address:
  • Phone: 917-684-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AHMOSE EL
Title or Position: TRUSTEE
Credential:
Phone: 917-684-4470