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General NPI Number Information
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NPI Number | 1497338891
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Entity Type | Organization
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Legal Business Name | BANSA ENTERPRISES INC
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 617 S DESERT STEPPES DR
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City | TUCSON
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State | AZ
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Zip | 85710-5940
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Country | US
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Telephone | 520-440-1412
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Fax |
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Provider Business Mailing Address
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Address Line | 6788 S SONORAN BLOOM AVE
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City | TUCSON
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State | AZ
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Zip | 85756-3040
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Country | US
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Telephone | 520-440-1412
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PRUDENTIA TAKU
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Credential |
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Telephone | 520-440-1412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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