Provider Demographics
NPI:1114272416
Name:ARIZONA BEHAVIORAL CARE HOMES LLC
Entity Type:Organization
Organization Name:ARIZONA BEHAVIORAL CARE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CRAWFORD
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:480-840-1601
Mailing Address - Street 1:4645 S LAKESHORE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7152
Mailing Address - Country:US
Mailing Address - Phone:480-840-1601
Mailing Address - Fax:480-840-1613
Practice Address - Street 1:1024 N RIDGE CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5129
Practice Address - Country:US
Practice Address - Phone:480-332-4281
Practice Address - Fax:480-306-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4067320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness