Organization
MWANGAZA RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONAH KIBITOK MAIYO 04/05/1979 (CEO/PROGRAM DIRECTOR)
(520) 248-1295
Entity
Organization
Contact information
Practice address
2234 E CALLE SIERRA DEL MANANTIAL, TUCSON, AZ 85706-5052
(520) 207-9283
(520) 207-9283
Mailing address
2234 E CALLE SIERRA DEL MANANTIAL, TUCSON, AZ 85706-5052
(520) 207-9283
(520) 207-9283
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-3425
AZ
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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