| NPI | 1083967376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INDRA DAYANA GARCIA CHAVEZ Administrative Services Manager 602-285-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: AZ BH4104) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2025-09-02 |