| NPI | 1659918266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA SHAKESPEARE Billing Compliance Officer 928-554-5633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2020-01-31 |