| Organization Name: | BASAMI HOUSE,LLC |
| NPI Number: | 1710394614 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOYCE 0DONGO (MEMBER) |
| Mailing Address: | 15434 N 10th Ave Phoenix |
| State: | AZ US |
| Postal Code: | 850234476 |
| Phone Number: | 6024392316 |
| Fax Number: | |
| NPI Enumeration Date: | 07/13/2014 |
| NPI Last Update Date: | 07/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | BH 4444 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |