| NPI | 1104091701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE ANN ROUBA Pmhnp/Pnp 928-341-0409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: NY F401029-1) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |