Healthcare Provider Details

I. General information

NPI: 1295071330
Provider Name (Legal Business Name): BETHEL RIDGE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S MAPLE AVE
BASKING RIDGE NJ
07920-1280
US

IV. Provider business mailing address

PO BOX 138
BASKING RIDGE NJ
07920-0138
US

V. Phone/Fax

Practice location:
  • Phone: 908-221-0801
  • Fax: 908-221-9169
Mailing address:
  • Phone: 908-221-0801
  • Fax: 908-221-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberGH957
License Number StateNJ

VIII. Authorized Official

Name: MRS. CAROLINE NESMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 908-221-0801