Individual
IBRAHIM KRESO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
121 E FOUR HORSES PL, TUCSON, AZ 85704-7210
(520) 742-5913
(520) 742-5913
Mailing address
121 E FOUR HORSES PL, TUCSON, AZ 85704-7210
(520) 742-5913
(520) 742-5913
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
BH-3784
AZ
385H00000X
Respite Care
Primary
BH3784
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH3784
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
02/28/2011
Last updated
10/18/2019
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