Healthcare Provider Details

I. General information

NPI: 1790297216
Provider Name (Legal Business Name): BEDFORD TRANSITIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 I ST STE 2
BEDFORD IN
47421-2955
US

IV. Provider business mailing address

1127 BARTLETTSVILLE RD
BEDFORD IN
47421-7953
US

V. Phone/Fax

Practice location:
  • Phone: 812-675-0902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEANNA FORD
Title or Position: CO-OWNER
Credential:
Phone: 812-675-0902