| NPI | 1477843175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MBONG JERRY NGWESE Co Owner 480-233-9241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AZ BH3810) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |