Provider Demographics
NPI:1326432741
Name:PASTALINO MANOR LLC 2
Entity Type:Organization
Organization Name:PASTALINO MANOR LLC 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MUNYAO
Authorized Official - Last Name:KIVILA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:480-634-5485
Mailing Address - Street 1:1393 W KESLER LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7229
Mailing Address - Country:US
Mailing Address - Phone:480-634-5485
Mailing Address - Fax:480-699-7288
Practice Address - Street 1:1383 W KESLER LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7289
Practice Address - Country:US
Practice Address - Phone:480-634-5485
Practice Address - Fax:480-699-7288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH 4431251S00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness