| NPI | 1235657461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WILLIAMS Claims Mgr 520-526-1028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: AZ OTC8336) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ OTC8336) | |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2019-07-01 |