| NPI | 1578077632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE CLARK Billing 928-460-0593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BL04112) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2017-11-28 |