| NPI | 1104475763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTELLE EZINNE OGUADIMMA Chief Executive Officer 480-720-3393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 251S00000X | |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2021-06-21 |