| NPI | 1447688502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH LEE Clinical Director 602-503-3909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AZ BH-4166) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2013-10-28 |