Provider Demographics
NPI:1891283149
Name:BBC WHITTON, LLC
Entity Type:Organization
Organization Name:BBC WHITTON, LLC
Other - Org Name:BBC MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-223-2546
Mailing Address - Street 1:PO BOX 44701
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-4701
Mailing Address - Country:US
Mailing Address - Phone:602-875-0409
Mailing Address - Fax:
Practice Address - Street 1:1106 E WHITTON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5053
Practice Address - Country:US
Practice Address - Phone:602-626-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUILDING BLOCKS COUNSELING,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5269324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility