| NPI | 1174210041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELVIS DICKSON Co Founder/Gen Part 480-984-1795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2024-07-24 |