Organization · NPI-2

Ctb Az, LLC

Custodial Care Facility, Adult Care Home · Tempe, AZ

NPI number1770195612

StatusActive

Last updated in NPPESAug 21, 2020

Details

NPI: 1770195612
Entity type: Organization (NPI-2)
Legal business name: Ctb Az, LLC
Organization subpart: No
Enumeration date: Aug 21, 2020
Certification date: Aug 21, 2020
Last updated: Aug 21, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
311ZA0620X	Custodial Care Facility, Adult Care Home	–	–	Yes
225100000X	Physical Therapist	–	–
225X00000X	Occupational Therapist	–	–
235Z00000X	Speech-Language Pathologist,	–	–
251C00000X	Day Training, Developmentally Disabled Services	–	–
320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities	–	–
373H00000X	Day Training/Habilitation Specialist	–	–
385HR2060X	Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child	–	–

Practice location

2075 S Cottonwood Dr
Tempe, AZ 85282-3040

Phone 602-318-2041

Mailing address

2401 W Southern Ave Lot 462
Tempe, AZ 85282-4342

Phone 602-318-2041

Authorized official

Kelly Masengale
Owner
6023182041

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