| NPI | 1205424405 |
|---|---|
| Former Legal Business Name | MAGENTA HAZE PR |
| Entity Type | Organization |
| Authorized Contact | CHARDE PETRUS Director 661-797-4018 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 167G00000X Licensed Psychiatric Technician | |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-01-05 |