Organization
AMANDA'S CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIUS A BUTAS MANAGER (MANAGER ASSISTED LIVING)
(480) 373-8437
Entity
Organization
Contact information
Practice address
8647 E PAMPA AVE, MESA, AZ 85212-1787
(480) 373-8437
(480) 373-8438
Mailing address
8647 E PAMPA AVE, MESA, AZ 85212-1787
(480) 373-8437
(480) 373-8438
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
ALH-A108
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
774267
AHCCCS PROVIDER ID NUMBER
AZ
Enumeration date
01/04/2007
Last updated
08/22/2020
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