| NPI | 1639640915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASSINDA KING BAYO Owner 602-733-9285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2018-12-11 |