Healthcare Provider Details
I. General information
NPI: 1598604225
Provider Name (Legal Business Name): BETHEL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5309 CAROLINE DR
HIGH RIDGE MO
63049-2481
US
IV. Provider business mailing address
16515 WESTGLEN FARMS DR
WILDWOOD MO
63011-1858
US
V. Phone/Fax
- Phone: 314-680-7689
- Fax:
- Phone: 314-680-7689
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QH0100X |
| Taxonomy | Health Service Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
NORMAN
NJIHI
Title or Position: MANAGER
Credential: DNP, FNP-C
Phone: 314-680-7689