| NPI | 1003600735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOFFAT BOEME MOLOSIWA Owner 602-476-9584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2025-04-07 |