| NPI | 1356051122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMMON D MANGUM Owner/ Partner 928-551-6099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2022-12-01 |
| Last Update Date | 2026-01-19 |