| NPI | 1285261891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSI R FORTSON Managing Member 480-868-8697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2022-03-28 |