Provider Demographics
NPI:1962008276
Name:BBC SCOTTSDALE LLC
Entity type:Organization
Organization Name:BBC SCOTTSDALE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-660-5775
Mailing Address - Street 1:3320 W CHERYL DR STE B120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9560
Mailing Address - Country:US
Mailing Address - Phone:480-660-5775
Mailing Address - Fax:
Practice Address - Street 1:3338 W KINGS AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2940
Practice Address - Country:US
Practice Address - Phone:480-660-5775
Practice Address - Fax:602-926-0590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BBC SCOTTSDALE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-10
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility