| NPI | 1043574577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH ANTHONY GRAY Insurance Coordinator 626-797-9977 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH-3965) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2012-06-29 |