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General NPI Number Information
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NPI Number | 1285260448
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Entity Type | Organization
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Legal Business Name | BBC SCOTTSDALE LLC
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 808 N 74TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-4310
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Country | US
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Telephone | 480-660-5775
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Fax | 480-660-5775
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Provider Business Mailing Address
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Address Line | 3320 W CHERYL DR STE B120
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City | PHOENIX
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State | AZ
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Zip | 85051-9560
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Country | US
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Telephone | 480-660-5775
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BRENT JOHNSTON
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Credential |
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Telephone | 480-660-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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