Provider Demographics
NPI:1659911576
Name:PASTALINO MANOR LLC 5
Entity Type:Organization
Organization Name:PASTALINO MANOR LLC 5
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:SR
Authorized Official - Credentials:
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:951-236-4717
Mailing Address - Fax:480-699-7288
Practice Address - Street 1:8815 S 57TH LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-5291
Practice Address - Country:US
Practice Address - Phone:480-634-5485
Practice Address - Fax:480-699-7288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASTALINO MANOR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility