Provider Demographics
NPI:1326767153
Name:SWALEA LLC
Entity Type:Organization
Organization Name:SWALEA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MWANDAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-858-1284
Mailing Address - Street 1:582 MANHATTAN WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8400
Mailing Address - Country:US
Mailing Address - Phone:714-858-1284
Mailing Address - Fax:
Practice Address - Street 1:4217 W MEDLOCK DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-2427
Practice Address - Country:US
Practice Address - Phone:714-858-2184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH7820OtherAZDHS