Provider Demographics
NPI:1265825418
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:
Mailing Address - Fax:
Practice Address - Street 1:16781 W HILTON AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7402
Practice Address - Country:US
Practice Address - Phone:602-904-2772
Practice Address - Fax:623-476-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH 4611320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness