Healthcare Provider Details

I. General information

NPI: 1760373773
Provider Name (Legal Business Name): BETHEL SKILLED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 DOCKERY AVE
SELMA CA
93662-3806
US

IV. Provider business mailing address

1817 AVENIDA DEL DIABLO
ESCONDIDO CA
92029-3112
US

V. Phone/Fax

Practice location:
  • Phone: 559-896-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KIRBY
Title or Position: MANAGER
Credential:
Phone: 619-201-5888