=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003862947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETHESDA, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2006
-----------------------------------------------------
Last Update Date | 04/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 873 S STEMMONS FWY STE 100
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-5351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-459-9999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 873 S STEMMONS FWY STE 100
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-5351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-459-9999
-----------------------------------------------------
Fax | 972-315-2065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/DON
-----------------------------------------------------
Name | KEHINDE ROMOKE AMOSUN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 972-420-0741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 009725
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------