| NPI | 1518250620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED R COGBURN CEO 928-376-0026 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH-3770) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2013-08-28 |