Organization
BASAMI HOUSE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE 0DONGO (MEMBER)
(602) 903-9193
Entity
Organization
Contact information
Practice address
15434 N 10TH AVE, PHOENIX, AZ 85023-4476
(602) 439-2316
Mailing address
PO BOX 42927, PHOENIX, AZ 85080-2927
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH 4444
AZ
Other
Enumeration date
07/13/2014
Last updated
07/13/2014
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