Individual
GRACE BASONGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6593 W CEDAR BRANCH WAY, TUCSON, AZ 85757-1514
(520) 312-2289
Mailing address
4000 N CENTRAL AVE STE 100, PHOENIX, AZ 85012-3520
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
ADBH20002
AZ
385H00000X
Respite Care
Primary
ADBH20002
AZ
Other
Enumeration date
09/04/2025
Last updated
10/24/2025
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