Provider Demographics
NPI:1003554239
Name:BETHEL HOMES LLC
Entity type:Organization
Organization Name:BETHEL HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGE
Authorized Official - Middle Name:STEPHIE
Authorized Official - Last Name:HODARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-409-7465
Mailing Address - Street 1:217 W GROVERS AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6515
Mailing Address - Country:US
Mailing Address - Phone:207-409-7465
Mailing Address - Fax:
Practice Address - Street 1:217 W GROVERS AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6515
Practice Address - Country:US
Practice Address - Phone:207-409-7465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH7551OtherAZDHS