MEDICARE: BETHEL HEALTH CARE CORP

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	310400000X	Assisted Living Facility	8627	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255675922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL HEALTH CARE CORP

Provider Business Mailing Address
First Line	:	2251 NW 29TH CT
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-2147
Country	:	US
Telephone Number	:	954-677-2900
Fax Number	:	954-486-5335

Provider Business Practice Location Address
First Line	:	2251 NW 29TH CT
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-2147
Country	:	US
Telephone Number	:	954-677-2900
Fax Number	:	954-486-5335

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SOLOMON MATHEW
Credential	:
Telephone Number	:	954-940-8555

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	11/19/2012

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Directions to “BETHEL HEALTH CARE CORP ” Practice Location

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