Provider Demographics
NPI:1295071330
Name:BETHEL RIDGE CORPORATION
Entity type:Organization
Organization Name:BETHEL RIDGE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NESMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-221-0801
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-0138
Mailing Address - Country:US
Mailing Address - Phone:908-221-0801
Mailing Address - Fax:908-221-9169
Practice Address - Street 1:175 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1280
Practice Address - Country:US
Practice Address - Phone:908-221-0801
Practice Address - Fax:908-221-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH957320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities