Healthcare Provider Details

I. General information

NPI: 1023430071
Provider Name (Legal Business Name): BETHEL MANAGEMENT GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROOKLYN BLVD STE 107
BROOKLYN CENTER MN
55429-2532
US

IV. Provider business mailing address

5901 BROOKLYN BLVD STE 107
BROOKLYN CENTER MN
55429-2532
US

V. Phone/Fax

Practice location:
  • Phone: 763-746-8566
  • Fax: 763-537-1688
Mailing address:
  • Phone: 763-746-8566
  • Fax: 763-537-1688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number365299
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number365299
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number365299
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number365299
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number365299
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number365299
License Number StateMN
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number365299
License Number StateMN

VIII. Authorized Official

Name: MR. JOSEPH BOAKYE-DANQUAH
Title or Position: PRESIDENT
Credential:
Phone: 612-423-0659