# LB PHOENIX BETHANY HOME ROAD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chris Ridge Village
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942355219
- **Authorized official:** MR. JAMES MICHAEL BAUSCH (GENERAL MANAGER)
- **Authorized official phone:** (602) 433-6416

## Contact information

- **Practice address:** 6246 N 19TH AVE, PHOENIX, AZ 85015-1511
- **Practice address phone:** (602) 433-6416
- **Practice address fax:** (602) 433-6458
- **Mailing address:** 6246 N 19TH AVE, PHOENIX, AZ 85015-1511
- **Mailing address phone:** (602) 433-6416
- **Mailing address fax:** (602) 433-6458

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 035116 | AZ | Yes |

## Other

- **Enumeration date:** 01/24/2007
- **Last updated:** 09/28/2007