Organization
BOUGAINVILLEA MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KRISHNA P ASHILI (ADMINISTRATOR)
(480) 239-9648
Entity
Organization
Contact information
Practice address
6646 S 57TH AVE, LAVEEN, AZ 85339-2254
(480) 239-9648
Mailing address
2083 COWAN DR, NEW BRAUNFELS, TX 78132-1695
(480) 239-9648
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/14/2024
Last updated
07/12/2024
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