Provider Demographics
NPI:1508423161
Name:AFFINITY BEHAVIORAL CARE, LLC
Entity Type:Organization
Organization Name:AFFINITY BEHAVIORAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CRAWFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-840-1601
Mailing Address - Street 1:5115 N DYSART RD # 437
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3032
Mailing Address - Country:US
Mailing Address - Phone:480-840-1601
Mailing Address - Fax:480-840-1613
Practice Address - Street 1:16575 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6192
Practice Address - Country:US
Practice Address - Phone:623-594-9064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness