Healthcare Provider Details

I. General information

NPI: 1265103931
Provider Name (Legal Business Name): BBXCS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BENJAMIN PL
MANTECA CA
95337-6524
US

IV. Provider business mailing address

425 BENJAMIN PL
MANTECA CA
95337-6524
US

V. Phone/Fax

Practice location:
  • Phone: 209-603-2249
  • Fax:
Mailing address:
  • Phone: 209-603-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA ALEXANDRENA SILVEIRA BURGOS
Title or Position: MANAGER
Credential: MED, BCBA
Phone: 209-603-2249