Provider Demographics
NPI:1669041240
Name:TUCSON RESIDENCE FOUNDATION INC.
Entity Type:Organization
Organization Name:TUCSON RESIDENCE FOUNDATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-790-9144
Mailing Address - Street 1:115 S SHERWOOD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4142
Mailing Address - Country:US
Mailing Address - Phone:520-790-9144
Mailing Address - Fax:520-790-9290
Practice Address - Street 1:115 S SHERWOOD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4142
Practice Address - Country:US
Practice Address - Phone:520-790-9144
Practice Address - Fax:520-790-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ017758Medicaid