Organization
MWANGAZA RESIDENTIAL CARE LLC
Active
Organization
MWANGAZA RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONAH KIBITOK MAIYO CEO/PROGRAM DIRECTOR (CEO/PROGRAM DIRECTOR)
(520) 248-1295
Entity
Organization
Contact information
Practice address
6330 S KOLB RD, TUCSON, AZ 85756-9287
(520) 248-1295
(520) 338-2490
Mailing address
8618 N WESTERN JUNIPER TER, TUCSON, AZ 85743-7132
(520) 248-1295
(520) 338-2490
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/08/2012
Last updated
10/09/2018
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