| NPI | 1164221172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD K FISHER Manager 602-907-1719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-03-11 |
| Last Update Date | 2025-05-21 |