Healthcare Provider Details

I. General information

NPI: 1003439472
Provider Name (Legal Business Name): BETHEL SKILLED HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 12/18/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 BOULEVARD
COLONIAL HEIGHTS VA
23834-1344
US

IV. Provider business mailing address

6024 IRONSTONE DR
NORTH CHESTERFIELD VA
23234-7725
US

V. Phone/Fax

Practice location:
  • Phone: 571-523-5479
  • Fax:
Mailing address:
  • Phone: 571-523-5479
  • Fax: 804-374-8889

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: DR. JESSY NWUBA
Title or Position: ADMINISTRATOR/OWNER
Credential: REGISTERED NURSE
Phone: 571-523-5479