| NPI | 1639681646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIUTA S FAAOOTOA Owner/Member 435-236-5424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH5273) |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2017-11-06 |