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General NPI Number Information
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NPI Number | 1881066363
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Entity Type | Organization
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Legal Business Name | BETHEL ASSISTED LIVING FACILITY, LLC
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 411 OCEANSIDE ST SW
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City | PALM BAY
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State | FL
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Zip | 32908-7127
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Country | US
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Telephone | 321-821-7498
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Fax | 321-325-8040
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Provider Business Mailing Address
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Address Line | 411 OCEANSIDE ST SW
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City | PALM BAY
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State | FL
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Zip | 32908-7127
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Country | US
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Telephone | 321-821-7498
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Fax | 321-325-8040
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Authorized Official
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Title or Position | ADMINISTRATOR / OWNER
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Name | MRS. JUNIA F OSIER
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Credential |
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Telephone | 321-961-1056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12711
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License Number State | FL
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