| NPI | 1063159069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA TANYA WILLIS Owner 623-887-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2023-09-29 |