Organization
BETHEL PROVIDER SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SEKINAT OLLA (OWNER)
(336) 340-4124
Entity
Organization
Contact information
Practice address
5204 CARRIAGE WOODS DR, BROWNS SUMMIT, NC 27214-9459
(336) 340-4124
(336) 617-0567
Mailing address
5483 HITCHING POST DR, GIBSONVILLE, NC 27249-9628
(336) 617-5761
(336) 617-0567
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL041931
NC
Other
Enumeration date
12/04/2009
Last updated
12/04/2009
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