Provider Demographics
NPI:1538487319
Name:THE COMFORT HOME
Entity Type:Organization
Organization Name:THE COMFORT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISSOUF
Authorized Official - Middle Name:
Authorized Official - Last Name:KONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-207-8015
Mailing Address - Street 1:5818 E. ROSEWOOD STREET
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-207-8015
Mailing Address - Fax:520-207-8138
Practice Address - Street 1:5818 E. ROSEWOOD STREET
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-207-8015
Practice Address - Fax:520-207-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3498320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness