| NPI | 1417774167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CARLISLE Administrator 623-693-2319 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-09-24 |