Provider Demographics
NPI:1104172865
Name:BELLWETHER RANCH FOUNDATION
Entity type:Organization
Organization Name:BELLWETHER RANCH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLOOMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-699-9155
Mailing Address - Street 1:11256 W BRIGHT SKY TRL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:AZ
Mailing Address - Zip Code:86046-7577
Mailing Address - Country:US
Mailing Address - Phone:928-699-9155
Mailing Address - Fax:928-222-2096
Practice Address - Street 1:402 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:AZ
Practice Address - Zip Code:86046-2702
Practice Address - Country:US
Practice Address - Phone:928-699-9155
Practice Address - Fax:928-222-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251C00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services