| NPI | 1447436506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR MANUEL PONDECA Owner 520-409-3991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH-2948) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2008-01-18 |