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General NPI Number Information
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NPI Number | 1104172865
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Entity Type | Organization
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Legal Business Name | BELLWETHER RANCH FOUNDATION
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 402 E ROUTE 66
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City | WILLIAMS
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State | AZ
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Zip | 86046-2702
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Country | US
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Telephone | 928-699-9155
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Fax | 928-222-2096
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Provider Business Mailing Address
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Address Line | 11256 W BRIGHT SKY TRL
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City | WILLIAMS
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State | AZ
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Zip | 86046-7577
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Country | US
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Telephone | 928-699-9155
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Fax | 928-222-2096
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Authorized Official
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Title or Position | OWNER / DIRECTOR
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Name | SHERRIAN D. BLOOMQUIST
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Credential | RN
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Telephone | 928-699-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State | AZ
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