Healthcare Provider Details

I. General information

NPI: 1629910260
Provider Name (Legal Business Name): BBC SCOTTSDALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E INDIANOLA AVE STE 200
PHOENIX AZ
85012-2168
US

IV. Provider business mailing address

40 E INDIANOLA AVE STE 200
PHOENIX AZ
85012-2168
US

V. Phone/Fax

Practice location:
  • Phone: 480-660-5775
  • Fax: 602-804-0020
Mailing address:
  • Phone: 480-660-5775
  • Fax: 602-804-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITNI MARK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 480-660-5775