Active NPI
Ibrahim Kreso
- Respite Care
- Tucson, AZ
National Provider Identifier
1346548385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Respite Care
- License
- BH3784
- Practice address
- 121 E Four Horses PL
Tucson, AZ 85704-7210 - Phone
- (520) 742-5913
- Fax
- (520) 742-5913
- NPI assigned
- Feb 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | BH-3784 | AZ | |
| Respite Care | 385H00000X | BH3784 | AZ | Primary |
Addresses
Primary practice location
121 E Four Horses PL
Tucson, AZ 85704-7210
Mailing address
121 E Four Horses PL
Tucson, AZ 85704-7210
Phone (520) 742-5913
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BH3784 | Other | AZ | AZ DEPT OF HEALTH SERVICES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BH-3784 | AZ | MD | Mental Illness Community Based Residential Treatment Facility |
| BH3784 | AZ | MD | Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571356800000",
"number": "1346548385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 E FOUR HORSES PL",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857047210",
"telephone_number": "520-742-5913",
"fax_number": "520-742-5913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 E FOUR HORSES PL",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857047210",
"telephone_number": "520-742-5913",
"fax_number": "520-742-5913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRESO",
"first_name": "IBRAHIM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-02-28",
"last_updated": "2019-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "AZ",
"license": "BH-3784",
"primary": false
},
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "AZ",
"license": "BH3784",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AZ DEPT OF HEALTH SERVICES",
"identifier": "BH3784",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.