| NPI | 1316624661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NGOZI EMETU Manager 480-200-7688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2023-07-31 |