Bethany Home Society of San Joaquin County, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100000015 Issued in CA

Legal business name

BETHANY HOME SOCIETY OF SAN JOAQUIN COUNTY, INC.

Practice address

930 W Main St
Ripon, CA 95366-2325

Phone

(209) 599-4221

Fax

(209) 599-7332

NPI assigned

Sep 8, 2005

Last updated

Oct 23, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keenon Krick

Title

Chief Executive Officer

Phone

(209) 313-1149

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487648135. Details of each certification follow.

• CCN 055662 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 055662

Legal name

BETHANY HOME SOCIETY OF SAN JOAQUIN COUNTY, INC.

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Feb 25, 1967

Last certification

Nov 4, 2022

Beds

92

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 15, 1958 in CA

Enrollment address

930 W Main Street
Ripon, CA 95366-2325

Nursing home name

BETHANY HOME SOCIETY SAN JOAQUIN COUNTY

Listed as

Bethany Home Society San Joaquin CountyCCN 055662 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Feb 25, 1967

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9256.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Daryl Ray Dutter, M.D.

  • Family Medicine Physician
  • Ripon, CA
  • NPI 1578568366

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Daryl Ray Dutter, M.D.

  • Family Medicine Physician
  • Ripon, CA
  • NPI 1578568366

  Nursing home

  Care Compare affiliation
• Kent Alan Hufford, M.D.

  • Family Medicine Physician
  • Ripon, CA
  • NPI 1487659272

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792713600000",
    "number": "1487648135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 W MAIN ST",
            "city": "RIPON",
            "state": "CA",
            "postal_code": "953662325",
            "telephone_number": "209-599-4221",
            "fax_number": "209-599-7332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 W MAIN ST",
            "city": "RIPON",
            "state": "CA",
            "postal_code": "953662325",
            "telephone_number": "209-599-4221",
            "fax_number": "209-599-7332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY HOME SOCIETY OF SAN JOAQUIN COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2026-10-23",
        "certification_date": "2026-10-23",
        "status": "A",
        "authorized_official_last_name": "KRICK",
        "authorized_official_first_name": "KEENON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "209-313-1149"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "100000015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR05662F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mariah Aniasco, AMFT, APCC
• Andrew Antos, DO
• Tana W Auzenne, DDS
• Deborah Lee Barton, D.C.
• Aram Bedikian, DC
• BHRS
• Devra Anne Bommarito, P.T.
• Kenneth D Bowman, P.A.-C
• Kim Bull
• California Connections Academy @ Ripon

• Skilled Nursing Facility in Ripon, CA
• Providers in Ripon, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.