Provider Demographics
NPI:1326259029
Name:BETHANY PLACE I, LTD
Entity Type:Organization
Organization Name:BETHANY PLACE I, LTD
Other - Org Name:ASHWOOD ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF TBR MNGMNT, INC.
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RUTTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:432-683-1824
Mailing Address - Street 1:PO BOX 3186
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79702-3186
Mailing Address - Country:US
Mailing Address - Phone:432-683-1824
Mailing Address - Fax:
Practice Address - Street 1:12151 HUNTERS CHASE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7960
Practice Address - Country:US
Practice Address - Phone:512-336-4100
Practice Address - Fax:512-336-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118190310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility