| NPI | 1114690468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANIS NTOUKAM Manager 602-802-4209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2022-04-14 |