Provider Demographics
NPI:1013609270
Name:B&B GROUP HOME LLC
Entity Type:Organization
Organization Name:B&B GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYUZUZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-350-9467
Mailing Address - Street 1:7315 W CORDES RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7315 W CORDES RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7262
Practice Address - Country:US
Practice Address - Phone:817-350-9467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B&B GROUP HOME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness