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General NPI Number Information
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NPI Number | 1457120818
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Entity Type | Organization
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Legal Business Name | PRESIDENTIAL MANSIONCARE, LLC
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 18428 W MIAMI ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-7490
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Country | US
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Telephone | 623-202-9583
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Fax | 623-822-0715
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Provider Business Mailing Address
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Address Line | 18428 W MIAMI ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-7490
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Country | US
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Telephone | 623-202-9583
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Fax | 623-822-0715
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Authorized Official
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Title or Position | CEO
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Name | KENNEDY AMUGHAN
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Credential | BHT, LLB, BL, JD CD.
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Telephone | 623-202-9583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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