Organization
PENALI MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY NYALITA (ADMINISTRATOR)
(302) 530-9489
Entity
Organization
Contact information
Practice address
8023 S 51ST DR, LAVEEN, AZ 85339-2840
(480) 207-1272
Mailing address
8023 S 51ST DR, LAVEEN, AZ 85339-2840
(302) 898-6406
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
BH5417
AZ
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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