Provider Demographics
NPI:1396439667
Name:MWANGAZA RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:MWANGAZA RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRO. DIR
Authorized Official - Prefix:
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:KIBITOK
Authorized Official - Last Name:MAIYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-207-9283
Mailing Address - Street 1:8618 N WESTERN JUNIPER TER
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7132
Mailing Address - Country:US
Mailing Address - Phone:520-248-1295
Mailing Address - Fax:888-977-2729
Practice Address - Street 1:3410 W RUTHANN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-8749
Practice Address - Country:US
Practice Address - Phone:520-248-1295
Practice Address - Fax:888-977-2729
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MWANGAZA RESIDENTIAL CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness