Healthcare Provider Details

I. General information

NPI: 1356520233
Provider Name (Legal Business Name): BETHANY HOME HEALTH OF LAKE JACKSON LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18333 PRESTON RD SUITE 410
DALLAS TX
75252-5466
US

IV. Provider business mailing address

207 THAT WAY ST SUITE C
LAKE JACKSON TX
77566-5211
US

V. Phone/Fax

Practice location:
  • Phone: 972-248-2441
  • Fax: 972-248-0773
Mailing address:
  • Phone: 979-297-1414
  • Fax: 979-297-1818

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