Provider Demographics
NPI:1871132514
Name:BETHANY HOME CARE LLC
Entity type:Organization
Organization Name:BETHANY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:QUEENCILIA
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:NGANDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-215-4806
Mailing Address - Street 1:1821 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-1806
Mailing Address - Country:US
Mailing Address - Phone:605-215-4806
Mailing Address - Fax:
Practice Address - Street 1:1821 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-1806
Practice Address - Country:US
Practice Address - Phone:605-215-4806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care