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General NPI Number Information
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NPI Number | 1174619092
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Entity Type | Organization
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Legal Business Name | BFB ASSISTED LIVING HOMES, LLC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1236 S PIONEER DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4772
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Country | US
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Telephone | 928-649-0275
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Fax | 928-649-0276
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Provider Business Mailing Address
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Address Line | 1001 S 10TH ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4428
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Country | US
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Telephone | 928-634-7198
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Fax | 928-634-1635
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. LORI MARIE FRUCHEY
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Credential |
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Telephone | 928-634-7198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALH-5769
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License Number State | AZ
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