Organization
LB PHOENIX BETHANY HOME ROAD LLC
Active
Other names
Chris Ridge Village
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES MICHAEL BAUSCH (GENERAL MANAGER)
(602) 433-6416
Entity
Organization
Contact information
Practice address
6246 N 19TH AVE, PHOENIX, AZ 85015-1511
(602) 433-6416
(602) 433-6458
Mailing address
6246 N 19TH AVE, PHOENIX, AZ 85015-1511
(602) 433-6416
(602) 433-6458
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
035116
AZ
Other
Enumeration date
01/24/2007
Last updated
09/28/2007
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