Provider Demographics
NPI:1679874853
Name:BETHANY HH OF DFW
Entity type:Organization
Organization Name:BETHANY HH OF DFW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-248-2441
Mailing Address - Street 1:PO BOX 260875
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-0875
Mailing Address - Country:US
Mailing Address - Phone:972-248-2441
Mailing Address - Fax:972-248-0773
Practice Address - Street 1:8701 W BEDFORD EULESS RD
Practice Address - Street 2:SUITE 320
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3804
Practice Address - Country:US
Practice Address - Phone:817-589-8811
Practice Address - Fax:817-589-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health