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Organization
BANSA ENTERPRISES INC
Active
Organization
BANSA ENTERPRISES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRUDENTIA TAKU (OWNER)
(520) 440-1412
Entity
Organization
Contact information
Practice address
6788 S SONORAN BLOOM AVE, TUCSON, AZ 85756-3040
(520) 440-1412
Mailing address
6788 S SONORAN BLOOM AVE, TUCSON, AZ 85756-3040
(520) 440-1412
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
NULL
103K00000X
Behavior Analyst
—
—
251E00000X
Home Health Agency
Primary
—
NULL
310400000X
Assisted Living Facility
—
NULL
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
NULL
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NULL
Other
Enumeration date
11/09/2020
Last updated
01/09/2021
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