Healthcare Provider Details

I. General information

NPI: 1053666248
Provider Name (Legal Business Name): BETHANY HH OF WEATHERFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 SANTA FE DR #200
WEATHERFORD TX
76086-5875
US

IV. Provider business mailing address

5000 LEGACY DR SUITE 360
PLANO TX
75024-3100
US

V. Phone/Fax

Practice location:
  • Phone: 817-341-1436
  • Fax: 817-341-2163
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 Number
License Number State

VIII. Authorized Official

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