| NPI | 1679153662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BOULAY Owner 480-356-4370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251B00000X Case Management |
| 261QR0401X Clinic/Center Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-04-13 |