| NPI | 1336790781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNWICK NATHAN Director 623-213-5356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children | |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2019-09-26 |