| NPI | 1497268163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINQUE INGRAM Owner 602-592-0503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV NV20171737643) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2017-11-16 |