NPIMap

Organization Active NPI

Presidential Mansioncare, LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Goodyear, AZ
National Provider Identifier
1437532991
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
BH2753 Issued in AZ
Legal business name
PRESIDENTIAL MANSIONCARE, LLC
Practice address
18428 W Miami St
Goodyear, AZ 85338-7490
Phone
(623) 202-9583
Fax
(623) 882-0715
NPI assigned
Jul 2, 2015
Last updated
Dec 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kennedy Abba Keday Amughan, BHT
Title
Executive Director
Phone
(623) 202-9583

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X BH2753 AZ Primary

Addresses

Primary practice location

18428 W Miami St
Goodyear, AZ 85338-7490

Mailing address

1647 S 170TH Ave
Goodyear, AZ 85338-7324
Phone (623) 202-9583

National Provider Directory

National Provider Directory
Tax ID family
Presidential Mansioncare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1437532991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1647 S 170TH AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853387324",
            "telephone_number": "623-202-9583",
            "fax_number": "623-215-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18428 W MIAMI ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853387490",
            "telephone_number": "623-202-9583",
            "fax_number": "623-882-0715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESIDENTIAL MANSIONCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-02",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "AMUGHAN",
        "authorized_official_first_name": "KENNEDY",
        "authorized_official_middle_name": "ABBA KEDAY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "623-202-9583",
        "authorized_official_credential": "BHT"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "BH2753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.