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
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/23/2018
Last updated
01/08/2021
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