| NPI | 1528529856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH J MIMS Owner/Program Director 602-507-0320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2019-03-28 |