| NPI | 1164169256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTE M MCLENDON Owner 623-666-3673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2023-07-06 |