# PASTALINO MANOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386940401
- **Authorized official:** MR. PAUL KIVILA (PROGRAM DIRECTOR)
- **Authorized official phone:** (951) 236-4717

## Contact information

- **Practice address:** 1383 W KESLER LN, CHANDLER, AZ 85224-7289
- **Practice address phone:** (480) 634-5485
- **Practice address fax:** (480) 634-5485
- **Mailing address:** 1383 W KESLER LN, CHANDLER, AZ 85224-7289
- **Mailing address phone:** (480) 634-5485
- **Mailing address fax:** (480) 634-5485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | BH-3710 | AZ | Yes |

## Other

- **Enumeration date:** 02/07/2011
- **Last updated:** 02/07/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | BH-3710 | AZ DEPT. OF HEALTH OBHL LICENSE NUMBER | AZ |