MEDICARE: BBC WHITTON, 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	324500000X	Substance Abuse Rehabilitation Facility	BH5269	AZ

General Provider Information

NPI Number	:	1891283149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BBC WHITTON, LLC

Provider Business Mailing Address
First Line	:	PO BOX 44701
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-4701
Country	:	US
Telephone Number	:	602-875-0409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 E WHITTON AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5053
Country	:	US
Telephone Number	:	602-626-8112
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE DIRECTOR
Name	:	MS. CHRISTINE STEVENS
Credential	:
Telephone Number	:	480-223-2546

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	04/23/2018

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