Provider Demographics
NPI:1174619092
Name:BFB ASSISTED LIVING HOMES, LLC
Entity type:Organization
Organization Name:BFB ASSISTED LIVING HOMES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
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 1:1236 S PIONEER DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4772
Practice Address - Country:US
Practice Address - Phone:928-649-0275
Practice Address - Fax:928-649-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5769310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ114608Medicaid