Healthcare Provider Details

I. General information

NPI: 1881781425
Provider Name (Legal Business Name): BETHANY HOME HEALTH OF SOUTHEAST TEXAS, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 CALDER ST SUITE 202
BEAUMONT TX
77702-1986
US

IV. Provider business mailing address

5000 LEGACY DR SUITE 360
PLANO TX
75024-3100
US

V. Phone/Fax

Practice location:
  • Phone: 409-835-8911
  • Fax: 409-839-8922
Mailing address:
  • Phone: 972-248-2441
  • Fax: 972-248-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number011609
License Number StateTX

VIII. Authorized Official

Name: BRADLEY P LASSITER
Title or Position: CEO
Credential:
Phone: 972-248-2441