Provider Demographics
NPI:1366643876
Name:BAL-TIP CORP
Entity Type:Organization
Organization Name:BAL-TIP CORP
Other - Org Name:BAL-TIP ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ENID
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-565-3231
Mailing Address - Street 1:3996 N BOWIE RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86413-9211
Mailing Address - Country:US
Mailing Address - Phone:928-565-3231
Mailing Address - Fax:928-565-7472
Practice Address - Street 1:3996 N BOWIE RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86413-9211
Practice Address - Country:US
Practice Address - Phone:928-565-3231
Practice Address - Fax:928-565-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH5490311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204806Medicaid