| NPI | 1417178724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA NEWPORT Credentialing/Licensing Manager 602-510-3514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: AZ LTC0176) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-11-09 |