| NPI | 1669644167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEIL HANSEN Owner/Administrator 928-726-6764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: AZ BH-2805) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |