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General NPI Number Information
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NPI Number | 1275284234
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Entity Type | Organization
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Legal Business Name | AMANDA'S CARE HOME II LLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 8647 E PAMPA AVE
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City | MESA
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State | AZ
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Zip | 85212-1787
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Country | US
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Telephone | 480-373-8437
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Fax |
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Provider Business Mailing Address
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Address Line | 3459 E VAUGHN AVE
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City | GILBERT
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State | AZ
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Zip | 85234-4247
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Country | US
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Telephone | 909-434-6940
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID WANJE
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Credential |
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Telephone | 909-434-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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