Healthcare Provider Details

I. General information

NPI: 1457265076
Provider Name (Legal Business Name): NAZARENE BETHTIVAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 W BROAD AVE
ALBANY GA
31707-4124
US

IV. Provider business mailing address

2021 W BROAD AVE
ALBANY GA
31707-4124
US

V. Phone/Fax

Practice location:
  • Phone: 516-343-4734
  • Fax:
Mailing address:
  • Phone: 516-343-4734
  • Fax: 516-343-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGIE CLAIRVIL SENE
Title or Position: OWNER
Credential:
Phone: 516-343-4734