| NPI | 1073158846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEHINDE LAWAL AO 623-703-8083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2019-11-15 |