MEDICARE: BAL-TIP CORP

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	311ZA0620X	Adult Care Home Facility	ALH5490	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366643876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAL-TIP CORP

Provider Business Mailing Address
First Line	:	3996 N BOWIE RD
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-9211
Country	:	US
Telephone Number	:	928-565-3231
Fax Number	:	928-565-7472

Provider Business Practice Location Address
First Line	:	3996 N BOWIE RD
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-9211
Country	:	US
Telephone Number	:	928-565-3231
Fax Number	:	928-565-7472

Authorized Official
Title or Position	:	OWNER-MANAGER
Name	:	ENID BALLENTINE
Credential	:
Telephone Number	:	928-565-3231

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/22/2020

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Directions to “BAL-TIP CORP ” Practice Location

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