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General NPI Number Information
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NPI Number | 1225825896
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Entity Type | Organization
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Legal Business Name | BETHEL HEALTH AGENCY
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 7517 BLUE SUN DR
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City | GLEN BURNIE
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State | MD
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Zip | 21060-8789
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Country | US
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Telephone | 240-469-0108
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Fax |
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Provider Business Mailing Address
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Address Line | 7517 BLUE SUN DR
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City | GLEN BURNIE
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State | MD
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Zip | 21060-8789
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Country | US
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Telephone | 240-469-0108
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | OPEYEMI IFEKOYA
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Credential |
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Telephone | 240-469-0108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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