Provider Demographics
NPI:1043920390
Name:AMANI INTEGRATED TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:AMANI INTEGRATED TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:WAMBUI
Authorized Official - Last Name:WAITHAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-591-8544
Mailing Address - Street 1:1717 W NORTHERN AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5471
Mailing Address - Country:US
Mailing Address - Phone:951-591-8544
Mailing Address - Fax:
Practice Address - Street 1:1717 W NORTHERN AVE STE 202A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5471
Practice Address - Country:US
Practice Address - Phone:951-591-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health