| NPI | 1366765190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE M MASTRANGELO Owner 520-820-3650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ 308244) |
| Additional Taxonomies | 251C00000X (Licence: AZ 308244) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2010-03-08 |