Organization
1514 BETHANY HOME MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES GUAJARDO (MANAGER)
(480) 384-0789
Entity
Organization
Contact information
Practice address
1514 W BETHANY HOME RD, PHOENIX, AZ 85015-2504
(602) 888-6779
Mailing address
14362 N FRANK LLOYD WRIGHT BLVD STE 1000, SCOTTSDALE, AZ 85260-8847
(480) 384-0789
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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