Healthcare Provider Details

I. General information

NPI: 1811044944
Provider Name (Legal Business Name): AMANDA'S CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8647 E PAMPA AVE
MESA AZ
85212-1787
US

IV. Provider business mailing address

8647 E PAMPA AVE
MESA AZ
85212-1787
US

V. Phone/Fax

Practice location:
  • Phone: 480-373-8437
  • Fax: 480-373-8438
Mailing address:
  • Phone: 480-373-8437
  • Fax: 480-373-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberALH-A108
License Number StateAZ

VIII. Authorized Official

Name: MR. MARIUS A BUTAS
Title or Position: MANAGER ASSISTED LIVING
Credential: MANAGER
Phone: 480-373-8437