Amanda'S Care Home LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

ALH-A108 Issued in AZ

Legal business name

AMANDA'S CARE HOME LLC

Practice address

8647 E Pampa Ave
Mesa, AZ 85212-1787

Phone

(480) 373-8437

Fax

(480) 373-8438

NPI assigned

Jan 4, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Marius A Butas, MANAGER

Title

Manager Assisted Living

Phone

(480) 373-8437

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811044944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8647 E PAMPA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852121787",
            "telephone_number": "480-373-8437",
            "fax_number": "480-373-8438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8647 E PAMPA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852121787",
            "telephone_number": "480-373-8437",
            "fax_number": "480-373-8438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMANDA'S CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUTAS",
        "authorized_official_first_name": "MARIUS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER ASSISTED LIVING",
        "authorized_official_telephone_number": "480-373-8437",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "AZ",
            "license": "ALH-A108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER ID NUMBER",
            "identifier": "774267",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Mesa, AZ
• Adult Care Home Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.