Provider Demographics
NPI:1922678416
Name:PASTALINO MANOR LLC
Entity Type:Organization
Organization Name:PASTALINO MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MUNYAO
Authorized Official - Last Name:KIVILA
Authorized Official - Suffix:SR
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:951-236-4717
Mailing Address - Fax:480-664-7668
Practice Address - Street 1:4929 E LAUREL LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4640
Practice Address - Country:US
Practice Address - Phone:951-236-4717
Practice Address - Fax:480-664-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness