| NPI | 1104209352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK LAWRENCE Manager 602-625-5808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH-4103) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |