Organization
CHARITE HOME
Active
Organization
CHARITE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL MUNYANKUMBURWA (ADMINISTRATOR)
(520) 721-1887
Entity
Organization
Contact information
Practice address
6057 S AVENIDA CANECA, TUCSON, AZ 85706-5073
(520) 721-1887
(520) 721-0069
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 721-0069
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6357
BUREAU OF RESIDENTIAL FACILITY LICENSING
AZ
Enumeration date
10/06/2020
Last updated
10/08/2020
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