| NPI | 1164836664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA BENITEZ MOORE Administrator 928-783-1505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH-4122) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2014-06-12 |