| NPI | 1437554359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORINA OGAZ Associate Director, Credentialing 602-636-3085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2023-05-23 |