| NPI | 1104373364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WILLIAMS Claims Mgr 520-526-1028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 284300000X Special Hospital (Licence: AZ IFBH8264) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ IFBH8264) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2019-04-04 |