Provider Demographics
NPI:1487923439
Name:WINDING WOODS MANOR L,L.C.
Entity type:Organization
Organization Name:WINDING WOODS MANOR L,L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE MGR. BHPP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:WANJA
Authorized Official - Last Name:KUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:480-600-5243
Mailing Address - Street 1:3691 S ASHLEY PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2618
Mailing Address - Country:US
Mailing Address - Phone:480-600-5243
Mailing Address - Fax:480-802-5753
Practice Address - Street 1:3691 S ASHLEY PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2618
Practice Address - Country:US
Practice Address - Phone:480-600-5243
Practice Address - Fax:480-802-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3950320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness