Provider Demographics
NPI:1831311034
Name:BETHEL RLC INC
Entity Type:Organization
Organization Name:BETHEL RLC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-332-9810
Mailing Address - Street 1:3362 E ROADRUNNER DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5704
Mailing Address - Country:US
Mailing Address - Phone:480-292-8605
Mailing Address - Fax:480-656-2596
Practice Address - Street 1:3362 E ROADRUNNER DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5704
Practice Address - Country:US
Practice Address - Phone:480-292-8605
Practice Address - Fax:480-656-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH5766310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility