Provider Demographics
NPI:1598367120
Name:BANSA ENTERPRISES INC
Entity Type:Organization
Organization Name:BANSA ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRUDENTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-440-1412
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:520-440-1412
Mailing Address - Fax:
Practice Address - Street 1:6788 S SONORAN BLOOM AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-3040
Practice Address - Country:US
Practice Address - Phone:520-440-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty