Healthcare Provider Details

I. General information

NPI: 1790865632
Provider Name (Legal Business Name): BETHSIDA HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16618 COBBLER CROSSING DR
SUGAR LAND TX
77478-7172
US

IV. Provider business mailing address

16618 COBBLER CROSSING DR
SUGAR LAND TX
77478-7172
US

V. Phone/Fax

Practice location:
  • Phone: 281-933-6012
  • Fax: 281-933-0682
Mailing address:
  • Phone: 281-933-6012
  • Fax: 281-933-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number677872
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number677872
License Number StateTX

VIII. Authorized Official

Name: MRS. STELLA NWAMAKA NZEADIBE
Title or Position: ADMIN DON
Credential:
Phone: 281-933-6012