| NPI | 1144796681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AGENDIA TAKU Member 520-388-9814 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2021-01-08 |