Provider Demographics
NPI:1871340646
Name:BETHEL HOUSE AFH LLC
Entity type:Organization
Organization Name:BETHEL HOUSE AFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AFH PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-859-3112
Mailing Address - Street 1:2510 B CT
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2510 B CT
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2003
Practice Address - Country:US
Practice Address - Phone:206-859-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home