Healthcare Provider Details

I. General information

NPI: 1962008276
Provider Name (Legal Business Name): BBC SCOTTSDALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 W KINGS AVE
PHOENIX AZ
85053-2940
US

IV. Provider business mailing address

3320 W CHERYL DR STE B120
PHOENIX AZ
85051-9560
US

V. Phone/Fax

Practice location:
  • Phone: 480-660-5775
  • Fax: 602-926-0590
Mailing address:
  • Phone: 480-660-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BRENT JOHNSTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 480-660-5775