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General NPI Number Information
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NPI Number | 1326259029
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Entity Type | Organization
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Legal Business Name | BETHANY PLACE I, LTD
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12151 HUNTERS CHASE DR
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City | AUSTIN
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State | TX
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Zip | 78729-7960
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Country | US
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Telephone | 512-336-4100
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Fax | 512-336-4155
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Provider Business Mailing Address
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Address Line | PO BOX 3186
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City | MIDLAND
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State | TX
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Zip | 79702-3186
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Country | US
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Telephone | 432-683-1824
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF TBR MNGMNT, INC.
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Name | MR. ALBERT WILLIAM RUTTER JR.
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Credential |
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Telephone | 432-683-1824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 118190
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License Number State | TX
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