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Organization
AZI HOUSE LLC
Active
Organization
AZI HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FUANGUNYI (CEO)
(520) 771-8605
Entity
Organization
Contact information
Practice address
6840 N CASSIM PL, TUCSON, AZ 85704-1261
(520) 600-2133
(520) 844-6343
Mailing address
5986 S JAKEMP TRL, TUCSON, AZ 85747-6003
(240) 643-0815
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6638
LICENSE NUMBER
AZ
Enumeration date
03/24/2021
Last updated
03/24/2021
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