Provider Demographics
| NPI: | 1386339356 |
|---|---|
| Name: | MB BEHAVIORAL RECOVERY & EMPOWERMENT LLC |
| Entity type: | Organization |
| Organization Name: | MB BEHAVIORAL RECOVERY & EMPOWERMENT LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BREANGELA |
| Authorized Official - Middle Name: | MYCHEAL |
| Authorized Official - Last Name: | WHITE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 602-435-8297 |
| Mailing Address - Street 1: | 2942 N 24TH ST STE 114 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85016-7849 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-435-8297 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 7303 E MAIN ST STE 112 |
| Practice Address - Street 2: | |
| Practice Address - City: | MESA |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85207-8325 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-435-8297 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-04-06 |
| Last Update Date: | 2023-04-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 251B00000X | Agencies | Case Management | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
| No | 261QR0800X | Ambulatory Health Care Facilities | Clinic/Center | Recovery Care |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
