| NPI | 1164964862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAY GREENE Manager 702-817-0372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2016-11-11 |