| NPI | 1306331509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GODFREY COO 602-688-0350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2024-07-29 |