Provider Demographics
NPI:1275284234
Name:AMANDA'S CARE HOME II LLC
Entity Type:Organization
Organization Name:AMANDA'S CARE HOME II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WANJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-434-6940
Mailing Address - Street 1:3459 E VAUGHN AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4247
Mailing Address - Country:US
Mailing Address - Phone:909-434-6940
Mailing Address - Fax:
Practice Address - Street 1:8647 E PAMPA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-1787
Practice Address - Country:US
Practice Address - Phone:480-373-8437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home