Provider Demographics
NPI:1598124075
Name:PASTALINO MANOR LLC 3
Entity Type:Organization
Organization Name:PASTALINO MANOR LLC 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIVILA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:480-634-5485
Mailing Address - Street 1:1383 W KESLER LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7289
Mailing Address - Country:US
Mailing Address - Phone:480-634-5485
Mailing Address - Fax:
Practice Address - Street 1:2264 W OLIVE WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4184
Practice Address - Country:US
Practice Address - Phone:480-404-7139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4822320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness