Healthcare Provider Details

I. General information

NPI: 1447477989
Provider Name (Legal Business Name): BETHANNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 2ND STREET PIKE
SOUTHAMPTON PA
18966-3955
US

IV. Provider business mailing address

1030 2ND STREET PIKE
SOUTHAMPTON PA
18966-3955
US

V. Phone/Fax

Practice location:
  • Phone: 215-355-6500
  • Fax: 215-355-8617
Mailing address:
  • Phone: 215-355-6500
  • Fax: 215-355-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number100910
License Number StatePA

VIII. Authorized Official

Name: MR. RONALD L FRITCH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 215-355-6500