| NPI | 1497102495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF TILLEY Mangager 602-695-4156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2019-02-06 |