| NPI | 1164768313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA J FURCH Clinical Coordinator 602-299-3545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: AZ BH4141) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2012-12-17 |