| NPI | 1598473290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS GASORE KABUNDA Manager 480-285-5907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2022-11-10 |