Provider Demographics
NPI:1114492766
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:
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 1:613 W DEVON CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-8029
Practice Address - Country:US
Practice Address - Phone:480-840-1601
Practice Address - Fax:480-840-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness