Provider Demographics
NPI:1295427896
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 1:7206 N 73RD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-2571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9418 W EATON RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4273
Practice Address - Country:US
Practice Address - Phone:817-350-9467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness