Provider Demographics
NPI:1750436523
Name:BETHEL RIDGE CORP
Entity type:Organization
Organization Name:BETHEL RIDGE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-221-0801
Mailing Address - Street 1:175 S MAPLE AVE
Mailing Address - Street 2:P.O. BOX138
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1280
Mailing Address - Country:US
Mailing Address - Phone:908-221-0801
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH 957385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child