Provider Demographics
NPI:1518311547
Name:WINDING WOODS MANOR L,L.C.
Entity Type:Organization
Organization Name:WINDING WOODS MANOR L,L.C.
Other - Org Name:WINDING WOODS MANOR II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARIUKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-707-7337
Mailing Address - Street 1:3977 E SCORPIO PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5908
Mailing Address - Country:US
Mailing Address - Phone:480-776-9261
Mailing Address - Fax:
Practice Address - Street 1:3438 E DERRINGER WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7778
Practice Address - Country:US
Practice Address - Phone:480-776-9261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4847320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness