MEDICARE: BETHANY PLACE I LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	030303	TX

General Provider Information

NPI Number	:	1982698411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY PLACE I LTD

Provider Business Mailing Address
First Line	:	PO BOX 3186
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79702-3186
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12151 HUNTERS CHASE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-7960
Country	:	US
Telephone Number	:	512-336-4100
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICER
Name	:	AW RUTTER
Credential	:
Telephone Number	:	915-683-1732

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/22/2020

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