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Organization

WEENDURE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AUSTIN COLE EGNEW (CEO)
(760) 289-2153
Entity
Organization

Contact information

Practice address
3621 N TALL PINE LN, PINE, AZ 85544-5767
(760) 289-2153
Mailing address
PO BOX 792, PINE, AZ 85544-0792

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
171M00000X
Case Manager/Care Coordinator
175T00000X
Peer Specialist
251300000X
Local Education Agency (LEA)
251S00000X
Community/Behavioral Health Agency
251V00000X
Voluntary or Charitable Agency
Primary
372600000X
Adult Companion
405300000X
Prevention Professional

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1013557149
AZ
Enumeration date
10/05/2022
Last updated
10/05/2022
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