# PRESIDENTIAL MANSIONCARE, LLC

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

## Provider details

- **NPI number:** 1437532991
- **Authorized official:** KENNEDY ABBA KEDAY AMUGHAN BHT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (623) 202-9583

## Contact information

- **Practice address:** 18428 W MIAMI ST, GOODYEAR, AZ 85338-7490
- **Practice address phone:** (623) 202-9583
- **Practice address fax:** (623) 882-0715
- **Mailing address:** 1647 S 170TH AVE, GOODYEAR, AZ 85338-7324
- **Mailing address phone:** (623) 202-9583
- **Mailing address fax:** (623) 215-2212

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | BH2753 | AZ | Yes |

## Other

- **Enumeration date:** 07/02/2015
- **Last updated:** 12/11/2023