Healthcare Provider Details

I. General information

NPI: 1912654476
Provider Name (Legal Business Name): IN BALANCE TRANSITIONAL LIVING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N CAMPBELL AVE SUITE 205
TUCSON AZ
85719-8571
US

IV. Provider business mailing address

6107 E GRANT RD
TUCSON AZ
85712-5828
US

V. Phone/Fax

Practice location:
  • Phone: 207-229-6315
  • Fax:
Mailing address:
  • Phone: 520-722-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY BARRASSO
Title or Position: COO
Credential: MPA, MLS
Phone: 520-722-9631