| NPI | 1619491123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA CODY Administrator 602-253-4570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2021-06-02 |