| NPI | 1568926376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN D DUFOUR Owner 928-231-1789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2021-09-07 |