| NPI | 1477105252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEPHANNIE JOUNG Owner/Administrator 623-312-8111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251E00000X Home Health |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2021-03-23 |