| NPI | 1154866853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOFFI SEDDO Administrator 520-891-0081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: AZ bh5068) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2017-01-04 |