Provider Demographics
NPI:1477247211
Name:SCOTTSDALE BH LLC
Entity Type:Organization
Organization Name:SCOTTSDALE BH LLC
Other - Org Name:SCOTTSDALE VIRTUAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-766-2973
Mailing Address - Street 1:6414 E BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1432
Mailing Address - Country:US
Mailing Address - Phone:480-766-2973
Mailing Address - Fax:
Practice Address - Street 1:6991 E CAMELBACK RD STE D300
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2492
Practice Address - Country:US
Practice Address - Phone:480-766-2973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder