| NPI | 1639983075 |
|---|---|
| Other Name | NONE |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA OLIVER Owner 623-221-2252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-02-05 |