MEDICARE: BBC SCOTTSDALE 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
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1962008276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BBC SCOTTSDALE LLC

Provider Business Mailing Address
First Line	:	3320 W CHERYL DR STE B120
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9560
Country	:	US
Telephone Number	:	480-660-5775
Fax Number	:

Provider Business Practice Location Address
First Line	:	3338 W KINGS AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2940
Country	:	US
Telephone Number	:	480-660-5775
Fax Number	:	602-926-0590

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BRENT JOHNSTON
Credential	:
Telephone Number	:	480-660-5775

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/17/2024

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Directions to “BBC SCOTTSDALE LLC ” Practice Location

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