MEDICARE: BETHANY HH OF NACOGDOCHES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174824361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY HH OF NACOGDOCHES

Provider Business Mailing Address
First Line	:	PO BOX 260875
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75026-0875
Country	:	US
Telephone Number	:	972-248-2441
Fax Number	:	972-248-0773

Provider Business Practice Location Address
First Line	:	3500 NORTH ST
Second Line	:	SUITE 1B
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2472
Country	:	US
Telephone Number	:	936-559-8555
Fax Number	:	936-559-8551

Authorized Official
Title or Position	:	CEO
Name	:	BRADLEY P. LASSITER
Credential	:
Telephone Number	:	972-248-2441

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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Directions to “BETHANY HH OF NACOGDOCHES ” Practice Location

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