| NPI | 1285418004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACHEL GRAY Owner 480-410-8944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261Q00000X Clinic/Center | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-08-22 |