Provider Demographics
NPI:1336860550
Name:HEALSONG HOME LLC
Entity Type:Organization
Organization Name:HEALSONG HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PASTEUR
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:MUGISHA
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:520-808-7220
Mailing Address - Street 1:2777 N BELL HOLLOW PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-8741
Mailing Address - Country:US
Mailing Address - Phone:520-808-7220
Mailing Address - Fax:
Practice Address - Street 1:2777 N BELL HOLLOW PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-8741
Practice Address - Country:US
Practice Address - Phone:520-808-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness