| NPI | 1013524230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VITTELIAN FORBES Owner 480-329-9585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-11-18 |