| NPI | 1255197406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESTINY NICOLE NORA CARTER Admin 602-317-1006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-02-26 |