| NPI | 1295558922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERENCE KIBUKAMUSOKE Owner 602-359-1706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 171W00000X Contractor |
| 251B00000X Case Management | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2024-11-01 |
| Last Update Date | 2024-11-01 |