MEDICARE: BETHANY LIFE LLC

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1609729268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY LIFE LLC

Provider Business Mailing Address
First Line	:	PO BOX 7181
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32314-7181
Country	:	US
Telephone Number	:	850-999-9695
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 SAWTOOTH DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-7368
Country	:	US
Telephone Number	:	850-999-9695
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MONICA TAINO
Credential	:
Telephone Number	:	850-999-9695

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “BETHANY LIFE LLC ” Practice Location

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