| NPI | 1134680820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUANIKA SHUNTAAYE SIMPSON-JACKSON Owner 602-698-8261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| 101YM0800X Counselor, Mental Health | |
| 251B00000X Case Management | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 251S00000X Community/Behavioral Health | |
| 252Y00000X Early Intervention Provider Agency | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2020-07-28 |