Healthcare Provider Details

I. General information

NPI: 1689120958
Provider Name (Legal Business Name): BEBOUT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 DAYTON ROAD NE
NEWARK OH
43055
US

IV. Provider business mailing address

1325 DAYTON ROAD NE
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 740-624-3210
  • Fax:
Mailing address:
  • Phone: 740-624-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK ALLEN BEBOUT
Title or Position: CEO
Credential:
Phone: 740-624-3210