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 |