| NPI | 1700269727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELPHINE MARIE THOMPSON Credentialing Specialist 4808-888-2123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: AZ BH4625) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2020-07-02 |