Organization
BETHEL HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGE STEPHIE HODARI (CEO)
(207) 409-7465
Entity
Organization
Contact information
Practice address
217 W GROVERS AVE, PHOENIX, AZ 85023-6515
(207) 409-7465
Mailing address
217 W GROVERS AVE, PHOENIX, AZ 85023-6515
(207) 409-7465
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH7551
AZDHS
AZ
Enumeration date
05/26/2022
Last updated
05/26/2022
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