| NPI | 1144679374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA CHANEL SHEMWELL Owner/Operator 928-587-9198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 1-13-12858) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2026-05-04 |