| NPI | 1194050278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK ORLANDER JACOBS Owner/Program Director 602-469-0802 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ BH3418) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: AZ BH3418) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2009-10-07 |