Provider Demographics
NPI:1881847671
Name:BFB ASSISTED LIVING HOMES, LLC
Entity Type:Organization
Organization Name:BFB ASSISTED LIVING HOMES, LLC
Other - Org Name:MINGUS MANOR ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRUCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-634-7198
Mailing Address - Street 1:1001 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4428
Mailing Address - Country:US
Mailing Address - Phone:928-634-7198
Mailing Address - Fax:928-634-1635
Practice Address - Street 1:25 W FIR ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4762
Practice Address - Country:US
Practice Address - Phone:928-649-1351
Practice Address - Fax:928-649-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-6705310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility