Provider Demographics
NPI:1619342201
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:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-840-1601
Mailing Address - Street 1:4645 S LAKESHORE DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-840-1601
Mailing Address - Fax:480-840-1613
Practice Address - Street 1:1101 E. GOLDCREST ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
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:2015-12-08
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4766320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness