| NPI | 1508228701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE M ELSON Long Term Care Provider 480-862-5741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2016-03-25 |