| NPI | 1528401072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN W JESKE CEO 928-379-0075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: AZ BH4228) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2013-04-15 |