Healthcare Provider Details

I. General information

NPI: 1235041948
Provider Name (Legal Business Name): BETHEL OAKS ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 GRAY SEA WAY
COLUMBIA MD
21045-7408
US

IV. Provider business mailing address

6322 GRAY SEA WAY
COLUMBIA MD
21045-7408
US

V. Phone/Fax

Practice location:
  • Phone: 703-651-6172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: DOREEN AMOAN
Title or Position: MEMBER
Credential: PHARMD
Phone: 703-651-6172