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General NPI Number Information
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NPI Number | 1871008219
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Entity Type | Organization
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Legal Business Name | ARIZONA BEHAVIORAL CARE HOMES LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 4349 N 161ST AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-6439
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Country | US
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Telephone | 480-840-1601
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Fax | 480-840-1613
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Provider Business Mailing Address
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Address Line | 4645 S LAKESHORE DR STE 3
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City | TEMPE
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State | AZ
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Zip | 85282-7152
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Country | US
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Telephone | 480-840-1601
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Fax | 480-840-1613
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT CRAWFORD BREEDLOVE
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Credential | LMSW
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Telephone | 480-840-1601
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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 | BH5316
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License Number State | AZ
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