| NPI | 1114171436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN LEE Chief Operating Offier 928-289-2650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ CSLG5954) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: AZ CSLG7215) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2021-07-26 |