Healthcare Provider Details

I. General information

NPI: 1124909882
Provider Name (Legal Business Name): B&M SUPPORT AND CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 W AVENUE J9
LANCASTER CA
93536-1735
US

IV. Provider business mailing address

6222 W AVENUE J9
LANCASTER CA
93536-1735
US

V. Phone/Fax

Practice location:
  • Phone: 424-391-0041
  • Fax:
Mailing address:
  • Phone: 424-391-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MISSY IFFORD
Title or Position: LICENSEE
Credential:
Phone: 424-391-0041