Komako House

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH3831 Issued in AZ

Legal business name

KOMAKO HOUSE

Practice address

3560 W Fenton Way
Tucson, AZ 85746-2550

Phone

(520) 272-7911

NPI assigned

Mar 15, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jean Siaha

Title

Director/Provider

Phone

(520) 272-7911

Specialties & licenses 1

Addresses

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300147200000",
    "number": "1073812152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3560 W FENTON WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857462550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3560 W FENTON WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857462550",
            "telephone_number": "520-272-7911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOMAKO HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-15",
        "last_updated": "2011-03-15",
        "status": "A",
        "authorized_official_last_name": "SIAHA",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "DIRECTOR/PROVIDER",
        "authorized_official_telephone_number": "520-272-7911",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH3831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Lynn Kolodny, LPC LISAC
• Rikki Ruthann Kolowich, AUD
• Tyler Jackson Kolzow, PT, DPT
• Arthur Kom Sipowa, MD
• Wagma Komak, PHARMD
• Christopher Bernard Komanapalli, M.D.
• Sitara Kommareddi, MD
• Akira Kondo, A.T.C
• Bradley Konecnik, DMD
• Naveen Konidala

• Mental Illness Community Based Residential Treatment Facility in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.