Provider Demographics
NPI:1710403712
Name:BBC GRACEFUL HOMES
Entity Type:Organization
Organization Name:BBC GRACEFUL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-626-8112
Mailing Address - Street 1:808 N 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-4310
Mailing Address - Country:US
Mailing Address - Phone:602-626-8112
Mailing Address - Fax:602-297-6758
Practice Address - Street 1:808 N 74TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-4310
Practice Address - Country:US
Practice Address - Phone:602-626-8112
Practice Address - Fax:602-297-6758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4859320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness