Provider Demographics
NPI:1932748738
Name:FANNA CARE LLC
Entity Type:Organization
Organization Name:FANNA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:FUANJIA
Authorized Official - Middle Name:NJUKENG
Authorized Official - Last Name:FUANGUNYI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-643-0558
Mailing Address - Street 1:6914 S BITTERCRESS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-5147
Mailing Address - Country:US
Mailing Address - Phone:240-643-0558
Mailing Address - Fax:
Practice Address - Street 1:6914 S BITTERCRESS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-5147
Practice Address - Country:US
Practice Address - Phone:240-643-0558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health