| NPI | 1528304367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LANG Resource Support Specialist 928-864-7371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH-3155) |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2023-07-14 |