| NPI | 1073209318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAMZA PAULSON Owner 602-592-0706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2023-04-11 |