| NPI | 1619491495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIJAH SISSE Program Director 480-302-1620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH5232) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2017-08-03 |