| NPI | 1659677870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILLYAS MALIK JENKINS Independent Contractor 702-462-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2011-02-05 |
| Last Update Date | 2011-02-05 |