Provider Demographics
NPI:1144796681
Name:BANSA HOUSE LLC
Entity Type:Organization
Organization Name:BANSA HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AGENDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-388-9814
Mailing Address - Street 1:6788 S SONORAN BLOOM AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-3040
Mailing Address - Country:US
Mailing Address - Phone:520-891-0513
Mailing Address - Fax:
Practice Address - Street 1:7225 E STELLA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-2336
Practice Address - Country:US
Practice Address - Phone:520-891-0513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANSA ENTERPRISES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-23
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances