Provider Demographics
NPI:1477396661
Name:BOUGAINVILLEA MANOR LLC
Entity type:Organization
Organization Name:BOUGAINVILLEA MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ASHILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-239-9648
Mailing Address - Street 1:2083 COWAN DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-1695
Mailing Address - Country:US
Mailing Address - Phone:480-239-9648
Mailing Address - Fax:
Practice Address - Street 1:6646 S 57TH AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2254
Practice Address - Country:US
Practice Address - Phone:480-239-9648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness