Provider Demographics
NPI:1245015080
Name:WILWAMH CARE LLC
Entity type:Organization
Organization Name:WILWAMH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHUNYO
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:508-423-9444
Mailing Address - Street 1:619 E LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-4148
Mailing Address - Country:US
Mailing Address - Phone:508-423-9444
Mailing Address - Fax:
Practice Address - Street 1:6705 E FLYNN AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-5110
Practice Address - Country:US
Practice Address - Phone:480-787-6790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health