Provider Demographics
NPI:1275310468
Name:LANGI, PAUL TONGA (BACHELOR'S DEGREE)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TONGA
Last Name:LANGI
Suffix:
Gender:M
Credentials:BACHELOR'S DEGREE
Other - Prefix:
Other - First Name:SKY TRIBE SERVICES
Other - Middle Name:
Other - Last Name:INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:36545 N TAKOTA TRL
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-1349
Mailing Address - Country:US
Mailing Address - Phone:801-472-0383
Mailing Address - Fax:
Practice Address - Street 1:36545 N TAKOTA TRL
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-1349
Practice Address - Country:US
Practice Address - Phone:801-472-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZQ06202315485251C00000X, 320600000X, 261QD1600X
AZ311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities