| NPI | 1568053734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUAMART LEWIS Program Administrator 623-680-6797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-02-01 |