| NPI | 1003504390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIME INGRAM Owner 480-329-0707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2023-04-26 |