| NPI | 1114781945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILDINE BURGESS Exec Admin 602-354-9252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-12 |