| NPI | 1679809636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY RAZO Executive Director 928-777-3280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ OTC8667) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: AZ BH-3420) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2018-03-07 |