Provider Demographics
NPI:1093430795
Name:WEENDURE, INC.
Entity Type:Organization
Organization Name:WEENDURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:EGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-289-2153
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:AZ
Mailing Address - Zip Code:85544-0792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3621 N TALL PINE LN
Practice Address - Street 2:
Practice Address - City:PINE
Practice Address - State:AZ
Practice Address - Zip Code:85544-5767
Practice Address - Country:US
Practice Address - Phone:760-289-2153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1013557149Medicaid