| NPI | 1598367120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRUDENTIA TAKU Owner 520-440-1412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 310400000X Assisted Living Facility | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2021-01-09 |