Healthcare Provider Details

I. General information

NPI: 1508993866
Provider Name (Legal Business Name): BETHAMY ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N SALISBURY AVE
SPENCER NC
28159-1828
US

IV. Provider business mailing address

909 N SALISBURY AVE
SPENCER NC
28159-1828
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-1985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberHAL080-006
License Number StateNC

VIII. Authorized Official

Name: MRS. SUSAN LANE MORRIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-633-1985