| NPI | 1205144094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVONNE CORDOVA STEVENSON Owner 623-418-8074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AZ 10017144) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2010-09-15 |