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General NPI Number Information
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NPI Number | 1013891928
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Entity Type | Organization
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Legal Business Name | BETHEL SUPPORT LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 375 GLENSPRINGS DR STE 400
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City | CINCINNATI
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State | OH
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Zip | 45246-2392
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Country | US
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Telephone | 513-250-8785
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Fax |
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Provider Business Mailing Address
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Address Line | 4175 CONTINENTAL DRIVE
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City | FAIRFIELD TWP
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State | OH
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Zip | 45011-2392
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Country | US
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Telephone | 513-250-8785
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Fax |
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Authorized Official
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Title or Position | OWNER/DOO
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Name | MISS BETHEL FOMONYUY KEWONG
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Credential | LPN
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Telephone | 513-250-8785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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