MEDICARE: ABBA BEHAVIORAL HEALTH,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1265967012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBA BEHAVIORAL HEALTH,LLC

Provider Business Mailing Address
First Line	:	21388 N 106TH LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-0522
Country	:	US
Telephone Number	:	623-414-0536
Fax Number	:

Provider Business Practice Location Address
First Line	:	21388 N 106TH LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-0522
Country	:	US
Telephone Number	:	623-414-0536
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LESLEY BRADLEY
Credential	:
Telephone Number	:	623-414-0536

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	04/28/2017

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