Organization
PASTALINO MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL KIVILA (PROGRAM DIRECTOR)
(951) 236-4717
Entity
Organization
Contact information
Practice address
1383 W KESLER LN, CHANDLER, AZ 85224-7289
(480) 634-5485
(480) 634-5485
Mailing address
1383 W KESLER LN, CHANDLER, AZ 85224-7289
(480) 634-5485
(480) 634-5485
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
BH-3710
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH-3710
AZ DEPT. OF HEALTH OBHL LICENSE NUMBER
AZ
Enumeration date
02/07/2011
Last updated
02/07/2011
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