| NPI | 1043028673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TII MAMBILLA CEO 928-279-2661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2024-12-30 |