Healthcare Provider Details

I. General information

NPI: 1780594200
Provider Name (Legal Business Name): MANTRA GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 W GLASS LN
LAVEEN AZ
85339-6943
US

IV. Provider business mailing address

5420 W GLASS LN
LAVEEN AZ
85339-6943
US

V. Phone/Fax

Practice location:
  • Phone: 602-312-6379
  • Fax: 866-553-9252
Mailing address:
  • Phone: 602-312-6379
  • Fax: 866-553-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ASLI HUSSEIN
Title or Position: OWNER
Credential:
Phone: 602-312-6379