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Organization
BANSA HOUSE LLC
Active
Organization
BANSA HOUSE LLC
Active
Parent organization
BANSA ENTERPRISES INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANSA ENTERPRISES INC
Authorized official
AGENDIA TAKU (MEMBER)
(520) 388-9814
Entity
Organization
Contact information
Practice address
7225 E STELLA RD, TUCSON, AZ 85730-2336
(520) 891-0513
Mailing address
6788 S SONORAN BLOOM AVE, TUCSON, AZ 85756-3040
(520) 891-0513
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
10/23/2018
Last updated
01/08/2021
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