Organization · NPI-2

1514 Bethany Home Management, LLC

Community Based Residential Treatment Facility, Mental Illness · Phoenix, AZ

NPI number1801369632
StatusActive
Last updated in NPPESJan 3, 2019

Details

NPI
1801369632
Entity type
Organization (NPI-2)
Legal business name
1514 Bethany Home Management, LLC
Organization subpart
No
Enumeration date
Jan 3, 2019
Last updated
Jan 3, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320800000X Community Based Residential Treatment Facility, Mental Illness––Yes
251B00000X Case Management––
251S00000X Community/Behavioral Health––
3104A0625X Assisted Living Facility, Assisted Living, Mental Illness––
310500000X Intermediate Care Facility, Mental Illness––

Practice location

1514 W Bethany Home Rd
Phoenix, AZ 85015-2504

Phone 602-888-6779

Mailing address

14362 N Frank Lloyd Wright Blvd Ste 1000
Scottsdale, AZ 85260-8847

Phone 480-384-0789

Authorized official

James Guajardo
Manager
4803840789

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