Healthcare Provider Details

I. General information

NPI: 1174619092
Provider Name (Legal Business Name): BFB ASSISTED LIVING HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 S PIONEER DR
COTTONWOOD AZ
86326-4772
US

IV. Provider business mailing address

1001 S 10TH ST
COTTONWOOD AZ
86326-4428
US

V. Phone/Fax

Practice location:
  • Phone: 928-649-0275
  • Fax: 928-649-0276
Mailing address:
  • Phone: 928-634-7198
  • Fax: 928-634-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALH-5769
License Number StateAZ

VIII. Authorized Official

Name: MRS. LORI MARIE FRUCHEY
Title or Position: MEMBER
Credential:
Phone: 928-634-7198