| NPI | 1679067946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIELA DEL MORAL Owner/Manager 928-864-9702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: AZ BH5453) |
| Additional Taxonomies | 251B00000X Case Management (Licence: AZ BH5453) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH5453) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2018-06-19 |