Provider Demographics
NPI:1942322425
Name:BETHANY RANCH HOME, INC
Entity Type:Organization
Organization Name:BETHANY RANCH HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NMD, RN, BSN, MSN
Authorized Official - Phone:602-616-3470
Mailing Address - Street 1:6130 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1705
Mailing Address - Country:US
Mailing Address - Phone:602-616-3470
Mailing Address - Fax:
Practice Address - Street 1:6130 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1705
Practice Address - Country:US
Practice Address - Phone:602-616-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251C00000X, 261QD1600X, 315P00000X, 320600000X, 320900000X, 347C00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Not Answered315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE2104999OtherARIZONA PROVIDER ID