MEDICARE: BETHEL PRIVATE HOME CARE AGENCY

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1255030680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL PRIVATE HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	5183 BROWN LEAF WAY
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-8911
Country	:	US
Telephone Number	:	770-912-8105
Fax Number	:

Provider Business Practice Location Address
First Line	:	5183 BROWN LEAF WAY
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-8911
Country	:	US
Telephone Number	:	770-912-8105
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YETUNDE OLA ALOBA
Credential	:
Telephone Number	:	770-912-8105

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	02/24/2023

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