| NPI | 1174041883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN CAROL JORDE Director 602-216-0518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH5176) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH5177) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2023-07-28 |