Penali Manor LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

BH5417 Issued in AZ

Legal business name

PENALI MANOR LLC

Practice address

8023 S 51St Dr
Laveen, AZ 85339-2840

Phone

(480) 207-1272

NPI assigned

May 15, 2018

Organization subpart

No

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

Authorized official

Name

Peggy Nyalita

Title

Administrator

Phone

(302) 530-9489

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1992295984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8023 S 51ST DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853392840",
            "telephone_number": "302-898-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8023 S 51ST DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853392840",
            "telephone_number": "480-207-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENALI MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-15",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "NYALITA",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "302-530-9489"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "BH5417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Laveen, AZ
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; 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.