| NPI | 1184104812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA SHAKESPEARE Billing Compliance Officer 928-554-5633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ XT4080190) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2020-01-31 |